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
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 Chapter1, 2024 Acts of Assembly $5,824,897,704 $14,857,958,805 $20,682,856,509
2022-2024 2024 Chapter1, 2024 Acts of Assembly $5,876,121,463 $16,797,807,713 $22,673,929,176
2024-2026 2025 Chapter 7, 2026 Acts of Assembly $7,209,890,810 $19,062,899,817 $26,272,790,627
2024-2026 2026 Chapter 7, 2026 Acts of Assembly $8,038,519,706 $20,693,477,358 $28,731,997,064
2026-2028 2027 Chapter 1. 2026 Acts of Assembly, Special Session I $8,616,824,970 $21,985,384,319 $30,602,209,289
2026-2028 2027 Base Budget $7,622,621,275 $19,926,298,195 $27,548,919,470
2026-2028 2027 Governor's Amendments $916,867,958 $1,979,524,356 $2,896,392,314
2026-2028 2027 General Assembly Adjustments $77,335,737 $79,561,768 $156,897,505
2026-2028 2028 Chapter 1. 2026 Acts of Assembly, Special Session I $9,172,140,731 $23,053,011,894 $32,225,152,625
2026-2028 2028 Base Budget $7,622,621,275 $19,926,298,195 $27,548,919,470
2026-2028 2028 Governor's Amendments $1,451,303,297 $3,025,744,085 $4,477,047,382
2026-2028 2028 General Assembly Adjustments $98,216,159 $100,969,614 $199,185,773
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
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 Chapter1, 2024 Acts of Assembly 266.02 276.98 543.00
2022-2024 2024 Chapter1, 2024 Acts of Assembly 263.52 279.48 543.00
2024-2026 2025 Chapter 7, 2026 Acts of Assembly 274.02 292.98 567.00
2024-2026 2026 Chapter 7, 2026 Acts of Assembly 276.52 295.48 572.00
2026-2028 2027 Chapter 1. 2026 Acts of Assembly, Special Session I 278.02 318.98 597.00
2026-2028 2027 Base Budget 276.52 295.48 572.00
2026-2028 2027 Governor's Amendments 1.50 23.50 25.00
2026-2028 2027 General Assembly Adjustments 0.00 0.00 0.00
2026-2028 2028 Chapter 1. 2026 Acts of Assembly, Special Session I 278.02 321.98 600.00
2026-2028 2028 Base Budget 276.52 295.48 572.00
2026-2028 2028 Governor's Amendments 1.50 26.50 28.00
2026-2028 2028 General Assembly Adjustments 0.00 0.00 0.00
Operating Budget Addenda (in order of greatest impact)
•
Remove funding for vetoed weight loss medication coverage Base Budget Adjustment
  Removes funding associated with expanded weight loss medication coverage in Medicaid to reflect the Governor's veto of Paragraph TTTT.2 of Item 288, Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($6,858,938) ($6,858,938)
Nongeneral Fund ($39,829,380) ($39,829,380)
•
Remove funding for vetoed nursing facility rate increase Base Budget Adjustment
  Removes funding associated with a Medicaid rate increase for nursing facilities to reflect the Governor's veto of Paragraph VVVVV of Item 288, Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($10,000,000) ($10,000,000)
Nongeneral Fund ($11,650,000) ($11,650,000)
•
Adjust appropriation for centrally funded salary increases for state employees Base Budget Adjustment
  Adjusts appropriation for the salary increases for state employees budgeted in Central Appropriations, Item 469 R. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund $2,420,036 $2,420,036
Nongeneral Fund $2,110,998 $2,110,998
•
Remove funding for mobile maternal health pilot program Base Budget Adjustment
  Removes one-time funding associated with a mobile maternal health pilot program. The Department of Medical Assistance Services will examine options for transitioning this service to managed care in future years.
 
  FY FY
General Fund ($1,250,000) ($1,250,000)
Nongeneral Fund ($1,250,000) ($1,250,000)
•
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 469 G. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund $672,776 $672,776
Nongeneral Fund $478,875 $478,875
•
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 470 C. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($87,675) ($87,675)
Nongeneral Fund ($116,080) ($116,080)
•
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 469 H. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($89,462) ($89,462)
Nongeneral Fund ($68,242) ($68,242)
•
Adjust appropriation for centrally funded 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 469 J. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($82,949) ($82,949)
Nongeneral Fund ($72,329) ($72,329)
•
Adjust appropriation for centrally funded workers’ compensation premium changes Base Budget Adjustment
  Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 469 O. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($111,328) ($111,328)
Nongeneral Fund ($20,352) ($20,352)
•
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 470 G. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund $26,039 $26,039
Nongeneral Fund $76,341 $76,341
•
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 470 F. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($69,154) ($69,154)
Nongeneral Fund ($11,184) ($11,184)
•
Adjust appropriation for centrally funded changes to agency rental costs Base Budget Adjustment
  Adjusts appropriation for changes to agency rental costs at the seat of government budgeted in Central Appropriations, Item 470 D. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund $35,499 $35,499
Nongeneral Fund $35,498 $35,498
•
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 470 E. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund ($28,497) ($28,497)
Nongeneral Fund ($21,521) ($21,521)
•
Adjust appropriation for centrally funded changes to agency leased space costs Base Budget Adjustment
  Adjusts appropriation for reduced charges to customer agencies for the Department of General Services to perform lease administration services budgeted in Central Appropriations, Item 470 I. of Chapter 725, 2025 Acts of Assembly.
 
  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 assumed increase in the Virginia minimum wage effective January 1, 2026, and budgeted in Central Appropriations, Item 469 Q. of Chapter 725, 2025 Acts of Assembly. The amounts provided support the annualized general fund cost of increasing the Virginia minimum wage from $12.00 per hour to $12.89 per hour or the equivalent annual salary of $26,811. The actual minimum wage for January 1, 2026 will be communicated by the Commissioner of the Department of Labor and Industry by October 1, 2025.
 
  FY FY
General Fund $7,049 $7,049
•
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 470 M. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund $1,463 $1,463
Nongeneral Fund $1,464 $1,464
•
Adjust appropriation for centrally funded liability insurance premium charges Base Budget Adjustment
  Adjusts appropriation for liability insurance premiums billed by the Department of the Treasury’s Division of Risk Management budgeted in Central Appropriations, Item 470 J. of Chapter 725, 2025 Acts of Assembly.
 
  FY FY
General Fund $451 $451
Nongeneral Fund $451 $451
•
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 $1,073,580,407 $1,697,778,394
Nongeneral Fund $2,260,706,421 $3,586,603,491
•
Eliminate biennial inflation for medical assistance providers Decision Package
  Eliminates the automatic inflation adjustments that would have been provided for hospitals, freestanding psychiatric facilities, disproportionate share hospitals payments, graduate medical education payments, nursing facilities, and any other provider rates for fiscal years 2027 and 2028.
 
  FY FY
General Fund ($74,036,025) ($164,142,993)
Nongeneral Fund ($145,192,195) ($320,772,467)
•
Ensure appropriate utilization of crisis services Decision Package
  Makes changes to crisis services to ensure appropriate utilization of services. This includes applying a four-hour limit per incident and network changes for mobile crisis services and removes community stabilization as a covered service.
 
  FY FY
General Fund ($49,117,138) ($58,865,429)
Nongeneral Fund ($212,124,925) ($253,787,948)
•
Continue support for Rural Health Transformation Program Decision Package
  Provides appropriation to support the Rural Health Transformation Program pursuant to H.R. 1, 119th Congress (2025-2026). The department is authorized to hire up to 13 restricted positions that must be supported with program funds. These funds cannot be used to create any current or future obligation of state funding or state-supported services.
 
  FY FY
Nongeneral Fund $200,000,000 $200,000,000
Positions 13.00 13.00
•
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 $31,554,788 $48,559,695
Nongeneral Fund $55,579,414 $86,401,468
•
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 $41,450,000 $52,150,000
Nongeneral Fund ($41,450,000) ($52,150,000)
•
Account for preferred rebate on GLP-1 drugs through Medicaid Decision Package
  Enables the Medicaid program to leverage a direct agreement for pricing and drug rebates between the Commonwealth and the manufacturers of GLP-1 receptor agonist medications.
 
  FY FY
General Fund ($6,488,106) ($19,365,489)
Nongeneral Fund ($31,519,297) ($94,077,776)
•
Account for administrative inefficiencies in managed care Decision Package
  Requires a review of each managed care organization’s (MCO) administrative expenses. Attainable adjustments must be made in the capitation rate development calculation based on the results of this review to ensure efficient use of capitation revenues by the MCOs. Adjustments will be reflected in capitation rates effective July 1, 2026.
 
  FY FY
General Fund ($21,969,654) ($23,846,551)
Nongeneral Fund ($46,834,050) ($50,360,786)
•
Ensure appropriate utilization of applied behavior analysis services Decision Package
  Requires a diagnosis of autism spectrum disorder for an enrollee to receive applied behavior analysis (ABA) services. DMAS shall set a 20 hour per week cumulative limit on services provided under ABA. DMAS shall provide guidance on required ABA documentation and coordinate periodic pre- and post-payment reviews of ABA payments.
 
  FY FY
General Fund ($30,835,157) ($36,771,409)
Nongeneral Fund ($32,820,192) ($39,036,323)
•
Implement federal community engagement and eligibility verification requirements Decision Package
  Provides funding to support federal community engagement and eligibility verification requirements pursuant to H.R. 1, 119th Congress (2025-2026).
 
  FY FY
Nongeneral Fund $69,197,689 $65,215,723
Positions 9.00 12.00
•
Increase rates for developmental disability waiver services Decision Package
  Increases rates for services authorized under developmental disability waivers. These increases are necessary to comply with the order of permanent injunction resulting from the settlement agreement with the Department of Justice.
 
  FY FY
General Fund $28,024,587 $31,228,010
Nongeneral Fund $31,515,846 $35,024,265
•
Align the adult dental benefit with other insurance plans Decision Package
  Creates a $2,000 limit on annual spending per recipient on adult dental services. This change aligns the Medicaid adult dental benefit with coverage provided in other states and the state employee health plan.
 
  FY FY
General Fund ($9,883,707) ($13,695,995)
Nongeneral Fund ($41,929,302) ($58,102,033)
•
Standardize hourly limits across home and community-based waivers Decision Package
  Adjusts the hourly limit on personal care/assistance services provided under the developmental disability waivers to mirror the limits included in the Commonwealth Coordinated Care Plus waiver.
 
  FY FY
General Fund ($21,038,424) ($23,807,608)
Nongeneral Fund ($22,868,263) ($25,811,423)
•
Limit maternity services to emergency Medicaid for individuals who do not qualify for Medicaid solely on the basis of their citizenship status Decision Package
  Directs the department to limit coverage of maternity services for women who do not qualify for Medicaid solely on the basis of their citizenship status to those services covered under the Emergency Medicaid program.
 
  FY FY
General Fund ($13,209,963) ($16,276,704)
Nongeneral Fund ($21,432,904) ($26,161,845)
•
Appropriate funds to support private health system physician supplemental payments Decision Package
  Appropriates funds to support the estimated cost of future private health system physician supplemental payments and agency administrative costs. Pursuant to Appropriation Act language, the Department of Medical Assistance Services (DMAS) is authorized to make supplemental payments to private hospitals and related health systems that execute affiliation agreements with public entities that can transfer funds to DMAS for purposes of covering the non-federal share of the authorized payments. The funds appropriated through this technical adjustment will support three such agreements subject to future federal approvals.
 
  FY FY
Nongeneral Fund $35,551,741 $35,551,741
•
Remove duplicative members enrolled in other states Decision Package
  Accounts for savings from removal of individuals currently enrolled in Virginia’s medical assistance programs who have coverage in other states.
 
  FY FY
General Fund ($6,994,827) ($4,468,281)
Nongeneral Fund ($17,377,373) ($11,203,886)
•
Provide funding for centralized call center and eligibility operations Decision Package
  Adds funding to cover the expected cost of centralized call center and eligibility operations.
 
  FY FY
General Fund $2,332,112 $2,332,112
Nongeneral Fund $16,618,106 $16,618,106
•
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 ($1,998,997) $6,660,364
Nongeneral Fund ($5,131,420) $10,541,534
•
Authorize supplemental drug rebates for continuous glucose monitors and related supplies Decision Package
  Expands the supplemental rebate program to include continuous glucose monitors and certain diabetic supplies. Funding to support the necessary administrative contract is also provided.
 
  FY FY
General Fund ($2,386,885) ($2,365,555)
Nongeneral Fund ($8,236,115) ($8,126,445)
•
Account for changes in the Preferred Drug List Decision Package
  Accounts for changes adopted by the Pharmacy and Therapeutics committee related to the Preferred Drug List, also known as the common core formulary.
 
  FY FY
General Fund ($1,635,175) ($1,635,175)
Nongeneral Fund ($8,189,825) ($8,189,825)
•
Eliminate automatic increases for psychiatric residential treatment facilities and qualifying addiction and recovery treatment services providers Decision Package
  Eliminates future automatic inflation and rebasings that will be provided to psychiatric residential treatment facilities and qualifying addiction and recovery treatment services providers.
 
  FY FY
General Fund ($669,055) ($1,331,587)
Nongeneral Fund ($4,055,617) ($7,648,975)
•
Streamline service facilitation Decision Package
  Incorporates service facilitation into the statewide service broker contract.
 
  FY FY
General Fund ($2,130,903) ($2,228,737)
Nongeneral Fund ($2,165,111) ($2,261,653)
•
Strengthen oversight of personal care services Decision Package
  Removes the live-in caregiver exemption from electronic visit verification requirements. Reflects savings from strengthened oversight and enforcement processes to ensure consumer-directed personal care, respite and companion service providers meet electronic visit verification requirements. In addition, appropriate service restrictions are appropriately applied.
 
  FY FY
General Fund ($1,122,469) ($1,124,550)
Nongeneral Fund ($1,127,532) ($1,125,450)
•
Use civil money penalty funds to participate in federal nursing home staffing campaign Decision Package
  Authorizes participation in the federal Nursing Home Staffing Campaign administered by the Centers for Medicare and Medicaid Services. This program is aimed at increasing the number of nurses working in nursing facilities through financial incentives and training opportunities.
 
  FY FY
Nongeneral Fund $4,100,000 $0
•
Fund the cost of 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.
 
  FY FY
General Fund ($1,131,154) ($2,052,918)
•
Adjust federal appropriation for state facilities Decision Package
  Adjusts state facility appropriation to reflect the latest federal medical assistance percentage.
 
  FY FY
Nongeneral Fund ($1,043,672) ($1,148,340)
•
Reimburse the Virginia Center for Health Innovation for Medicaid related expenses Decision Package
  Provides appropriation and authority for the department to reimburse the Virginia Center for Health Innovation to draw federal match for expenses eligible for federal reimbursement.
 
  FY FY
Nongeneral Fund $100,000 $100,000
•
Authorize supplemental payments for Ballad Health Decision Package
  Provides authority to make supplemental payments through an adjustment to the formula for indirect medical education reimbursement for Ballad Health, upon the execution of affiliation agreements with public entities that are capable of transferring funds to the Department of Medical Assistance Services (DMAS) to cover the non-federal share of costs. Any funds to be transferred must comply with 42 CFR 433.51 and 433.54. DMAS must require all parties to attest to compliance with applicable federal criteria. The non-federal share of the agency's administrative costs directly related to administrating these payments must be funded by participating public entities.
•
Convert information technology contractors to full-time positions Decision Package
  Authorizes the conversion of three information technology contractors to classified positions. The converted positions will not increase net agency costs.
 
  FY FY
Positions 3.00 3.00
•
Delay implementation of a single pharmacy benefit manager system Decision Package
  Delays contracting with a single third-party administrator to serve as the state pharmacy benefits manager (PBM) until January 1, 2027, and such time as sufficient general fund support is provided through a general appropriation act. It is expected that general fund support and additional authority will be necessary to implement a single statewide PBM.
•
Delay implementation of redesigned behavioral health services Decision Package
  Delays the implementation of redesigned behavioral health services until January 1, 2027.
•
Enhance standards for nursing facility value-based purchasing program Decision Package
  Modifies the nursing facility value-based purchasing program to ensure that payments are only provided to those facilities that demonstrate a sufficiently high quality of care.
•
Improve long-term services and supports screenings Decision Package
  Requires the Department of Medical Assistance Services, in cooperation with the Virginia Department of Health, to create an assessment tool for children under the age of 18 to utilize in long-term services and supports screenings. In addition, the departments must implement measures necessary to ensure the consistent statewide application of screening criteria. Assessments cannot be conducted more frequently than once every six months unless a major life change occurs, regardless of the individual's age.
•
Require hospitals receiving enhanced payments to retain labor and delivery units Decision Package
  Eliminates private enhanced payments, authorized in § 3-5.15 of the Appropriation Act, to any hospital that shuts down a labor and delivery unit after January 1, 2026.
•
Require hospitals receiving rate assessment to contract with all Medicaid managed care organizations Decision Package
  Requires hospitals that receive hospital enhanced payments to contract with the network of each Medicaid managed care organization to ensure sufficient access to care for all Medicaid members.
•
Update graduate medical education residencies program to reflect new cohort Decision Package
  Authorizes 21 graduate medical education residency slots that will begin in July 2026. The new slots will be funded within existing appropriation.
•
Personal care rate increase (Exec Amend #4) General Assembly Adjustment
  This amendment increases consumer and agency-directed personal care rates by four percent on January 1, 2027, and 3.9 percent on January 1, 2028.
 
  FY FY
General Fund $20,470,156 $30,584,471
Nongeneral Fund $23,008,414 $34,212,134
•
Personal Care Rate Increase (291 #7c) General Assembly Adjustment
  This amendment provides $44.3 million GF and $49.6 million NGF the second year to provide an 8.1 percent rate increase for consumer and agency-directed personal care services on January 1, 2028, to reflect the impact from the increase in the state minimum wage.
 
  FY FY
General Fund $0 $44,269,979
Nongeneral Fund $0 $49,589,719
•
Modify Medicaid Managed Care Underwriting Provisions (291 #3c) General Assembly Adjustment
  This amendment lowers the assumed underwriting gain from 1.25 percent to 1.0 percent of Medicaid adjusted premium revenue in the development of capitations rates for the Medicaid Cardinal Care Managed Care program. Changes to the profit caps for the program beginning in fiscal year 2026, increased costs to the Medicaid program due to an increase the underwriting gain from 1.0 to 1.25 percent, contrary to provisions in the Appropriations Act (Ch. 725, 2025 Session of the General Assembly). This amendment would reverse that action and maintain the profit caps in place prior to this change.
 
  FY FY
General Fund ($13,698,140) ($16,644,387)
Nongeneral Fund ($28,004,172) ($33,546,378)
•
Restore FAMIS Prenatal Coverage for Pregnant and Postpartum Immigrant Persons (290 #1c) General Assembly Adjustment
  This amendment provides $13.2 million from the general fund and $21.4 million in nongeneral funds the first year and $16.3 million from the general fund and $26.2 million in nongeneral funds the second year to restore the FAMIS Prenatal Coverage Program that was proposed to be eliminated in the introduced budget.
 
  FY FY
General Fund $13,209,963 $16,276,704
Nongeneral Fund $21,432,904 $26,161,845
•
Nursing Home Reimbursement (291 #11c) General Assembly Adjustment
  This amendment adds $35.0 million GF and $35.0 million NGF to increase Medicaid nursing home reimbursement rates in fiscal year 2027. Language provides the Department of Medical Assistance Services with the authority to implement the rate increase as an added amount to the current per diem amount received by a nursing home or specialized care facility in the Cardinal Managed Care and fee-for-service programs.
 
  FY FY
General Fund $35,000,000 $0
Nongeneral Fund $35,000,000 $0
•
Developmental Disability Waiver Rates for Selected Services (291 #8c) General Assembly Adjustment
  This amendment provides $10.7 million GF and $10.7 million NGF the first year and $11.8 million GF and $11.8 million NGF the second year for the Department of Medical Assistance Services to increase the rates for State Plan, Developmental Disability, and other waiver services. This amendment adds additional services that were not included in the introduced budget.
 
  FY FY
General Fund $10,621,679 $11,835,816
Nongeneral Fund $10,621,679 $11,835,816
•
Medicaid ABA Services for Children Age 5 and Younger with Provisional Diagnosis (291 #18c) General Assembly Adjustment
  This amendment restores funding and modifies language in the introduced budget to allow for a provisional diagnosis of autism spectrum disorder for children age 5 or younger for one year using a protocol designated by the Department of Medical Assistance Services in order to receive Applied Behavioral Analysis (ABA) services. The introduced budget included language requiring a diagnosis of autism spectrum disorder in order to receive ABA services. A final diagnosis of autism spectrum in young children is often difficult. However, services are critical in assisting with communication, social interaction, daily routines, and managing challenging behaviors at a time when foundational skills are forming and the brain is developing rapidly. These services can have a major impact on later development.
 
  FY FY
General Fund $4,361,275 $5,200,887
Nongeneral Fund $4,563,297 $5,427,466
•
Medicaid and CHIP Participation in Cell and Gene Therapy Access Model for Sickle Cell Disease Treatment (291 #20c) General Assembly Adjustment
  This amendment adds funding and language to provide Medicaid, Medicaid Children's Health Insurance Program (M-CHIP) and Family Access to Medical Insurance Security (FAMIS) coverage for sickle cell treatments through a specific model of care in partnership with the federal Centers for Medicare and Medicaid (CMS). In 2025, CMS announced that 33 states, along with the District of Columbia and Puerto Rico, will be participating in the Cell and Gene Therapy (CGT) Access Model, including Virginia. The initial focus of the model is on access to gene therapy treatments for people living with sickle cell disease, a genetic blood disorder. The Cell and Gene Therapy (CGT) Access Model aims to improve the lives of people living with rare and severe diseases by increasing access to potentially transformative treatments. It is a multi-year, voluntary model for states and manufacturers to test whether a CMS-led approach to developing and administering outcomes-based agreements (OBAs) for cell and gene therapies increases access to innovative treatment, improves health outcomes, and reduces health care costs and burden to state Medicaid programs. Language also provides the agency with authority to unbundle the cost of the drugs from the cost of administer the drugs.
 
  FY FY
General Fund $3,496,496 $3,490,689
Nongeneral Fund $3,940,205 $3,871,012
•
Graduate Medical Education Residencies (291 #6c) General Assembly Adjustment
  This amendment provides $2.7 million GF and $2.7 million NGF each year to fund graduate medical education for 40 residents who began their residencies in July 2024, 55 residents who began their residencies in July 2025, and 35 residents who begin their residencies in July 2026, and 30 residents who begin their residencies in July 2027. It also increases the supplemental payment to hospitals for each qualifying residency slot from $100,000 to $145,000.
 
  FY FY
General Fund $2,700,000 $2,700,000
Nongeneral Fund $2,700,000 $2,700,000
•
Delay Implementation of A Single Medicaid Pharmacy Benefit Manager (295 #1c) General Assembly Adjustment
  This amendment adds $2.2 million from the general fund and $7.5 million from federal matching funds the first year to reflect the initial costs of implementing a single Medicaid Pharmacy Benefit Manager (PBM), pursuant to Chapter 701, 2025 Acts of Assembly. The amendment delays the implementation of a single pharmacy benefits manager contract for Medicaid until January 1, 2028. This allows the appropriate amount of time for the Department of Medical Assistance Services to complete the procurement process and take the appropriate steps for a successful implementation.
 
  FY FY
General Fund $2,174,667 $0
Nongeneral Fund $7,521,333 $0
•
Reduce First Year Administrative Costs (295 #3c) General Assembly Adjustment
  This amendment redirects $2.6 million from the general fund and $2.9 million from the nongeneral fund the first year from administrative costs in the Department of Medical Assistance Services provided in the introduced budget.)
 
  FY FY
General Fund ($2,614,200) $0
Nongeneral Fund ($2,939,892) $0
•
Medicaid Program Integrity Vendor (295 #9c) General Assembly Adjustment
  This amendment provides $1.0 million GF and $1.0 million NGF the first year for the Department of Medical Assistance to contract with a vendor to review the department's program integrity efforts, including such efforts within contracted managed care organizations.
 
  FY FY
General Fund $1,000,000 $0
Nongeneral Fund $1,000,000 $0
•
Pediatric Primary Care and Early Literacy Program (290 #2c) General Assembly Adjustment
  This amendment provides $252,000 GF and $468,000 NGF each year to contract with Reach Out and Read to implement a pilot program in select underserved localities of their evidence-based model that promotes early literacy and parental bonding as part of routine pediatric primary care visits. Language requires the Department of Medical Assistance Services to assess the implementation of the pilot program and provide an interim report on its findings by December 1, 2028. Note: This funding was moved to the correct service area, the entire amount was moved as GF.
 
  FY FY
General Fund $252,000 $252,000
Nongeneral Fund $468,000 $468,000
•
VHCF Project Connect for Medicaid Outreach and Enrollment (291 #4c) General Assembly Adjustment
  This amendment provides funding and language to expand the Virginia Health Care Foundation's (VHCF) Project Connect, which conducts outreach and enrollment services for the Medicaid programs. This expansion will ensure eligible Virginians can navigate the new federal Medicaid requirements, pursuant to H.R.1, Public Law No. 119-21, H.R. 1, 119th Cong. (2025-2026). This will fund up to six additional outreach workers, along with additional training resources. VHCF has contracted with DMAS for more than 25 years, helping to navigate every major change in the Virginia Medicaid program, enrolling more than 165,000 Virginians and training more than 20,000 community, health care, and social services staff.
 
  FY FY
General Fund $250,000 $250,000
Nongeneral Fund $250,000 $250,000
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Midwifery Workgroup (295 #8c) General Assembly Adjustment
  This amendment provides $111,841 general fund the first year for the Department of Medical Assistance Services and the Virginia Department of Health to convene a workgroup to identify the barriers that prevent certain midwives licensed by the Commonwealth of Virginia from contracting with managed care organizations (MCOs) through the Medicaid Cardinal Care Program. The purpose of the amendment is to find solutions to remove those barriers so that members can access a midwife and stay in their MCO.
 
  FY FY
General Fund $111,841 $0
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340B Reporting Requirement (291 #14c) General Assembly Adjustment
  This amendment sets out 340B data reporting requirements of covered entities.
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Applied Behavioral Analysis Workgroup (291 #13c) General Assembly Adjustment
  This amendment establishes a workgroup to evaluate utilization and best practices regarding for Medicaid Applied Behavioral Analysis services.
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Behavioral Health Redesign Implementation (291 #9c) General Assembly Adjustment
  This amendment delays the implementation of new Medicaid redesigned behavioral health services by six additional months from January 1, 2027, to July 1, 2027.
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Clarify language for Medicaid and CHIP participation in cell and gene therapy access model for sickle cell disease treatment (Exec Amend #3) General Assembly Adjustment
  This amendment clarifies and provides authority to implement the Centers for Medicare and Medicaid Services model of care.
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Deferral of Medicaid Nursing Facility Rebasing (291 #12c) General Assembly Adjustment
  This amendment adds language requiring the Department of Medical Assistance Services to defer scheduled nursing facility rebasing and examine the methodology used to rebase Medicaid rates for nursing facilities. Language requires the agency to work with stakeholders to identify and address methodological concerns and to propose modifications which address those concerns. It also requires that the agency and stakeholders review and recommend quality improvement initiatives to be incentivized within the payment rate as appropriate. Language requires the agency to report annually beginning December 1, 2026 through the deferral period to the Governor, the Senate Finance and Appropriations and Education and Health Committees, and the House Appropriations and Health and Human Services Committees. No authority is provided to make changes to the reimbursement system, but requires the next rebasing of nursing facility rates to be resumed for rates effective July 1, 2030.
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DMAS PACE Program in Shenandoah Valley (295 #5c) General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to expand to the Augusta/Rockingham/Harrisonburg area with a PACE program and to issue a Request for Proposals from entities interested in administering the program in the area. This region was previously opened up for PACE, although the awarded provider did not move forward with development.
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Extend Authority for Medicaid Neurobehavioral and Neurorehabilitation Facility Services (291 #16c) General Assembly Adjustment
  This amendment strikes language requiring the Department of Medical Assistance Services to seek the appropriate waiver authority for a demonstration project to add neurobehavioral and neurorehabilitation facilities to support 20 individuals with traumatic brain injuries and neurocognitive disorders by January 1, 2026. The department has been in negotiations with the federal Centers for Medicare and Medicaid (CMS) and will now have to modify the type of waiver it seeks to provide Medicaid coverage for these services. Language strikes the type of waiver, providing more flexibility to the department as it continues discussions with CMS on the waiver and eliminates the date of January 1, 2026 by which the department was required to seek the demonstration waiver.
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Fiscal Agent Employer Requirements (295 #10c) General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services (DMAS) to update Medicaid waiver rules to allow individuals receiving consumer-directed services to serve as their own employer of record (EOR) and to designate another person to perform EOR duties when they are unable. It also requires assignment of an employer identification number to the individual receiving services in specified circumstances and limits its transfer to other individuals to no more than twice per calendar year.
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Graduate Medical Education Technical Assistance and Reporting (291 #15c) General Assembly Adjustment
  This amendment establishes an annual data reporting process to evaluate the state-supported residency and fellowship training programs outlined in the budget. The Virginia Health Workforce Development Authority shall collect the information to be submitted. This amendment also requires DMAS to provide quarterly payment reports and for the Authority to report findings in its biennial report. This amendment also authorizes the Authority to create a technical assistance program and offer support services to residency and fellowship programs as a function of the Graduate Medical Education (GME) program for primary care and high-need specialties targeting rural and underserved areas. The Authority will report annually on program outcomes.
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Medicaid Enhanced Indirect Medical Education Supplemental Payments for Riverside Hospital (291 #2c) General Assembly Adjustment
  This amendment authorizes the Department of Medical Assistance Services (DMAS) to implement enhanced Medicaid indirect medical education (IME) payments for Riverside Regional Medical Center, reflecting the size and strategic importance of their medical intern and resident teaching program to the region as a level two trauma center in the Peninsula EMS Region. This amendment does not require any general fund as the non-federal share of enhanced IME payments must be covered by a public entity capable of transferring funds to DMAS for the purposes of covering the non-federal share of the authorized payments.
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Medicaid Financial Sustainability Workgroup (295 #7c) General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to convene a Medicaid Financial Sustainability Workgroup for the purpose of analyzing Medicaid expenditure trends and identifying strategies to moderate the rate of spending growth while preserving access to care, quality, and compliance with state and federal law and policy.
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Medicaid Reimbursement for Rehabilitation Hospitals (291 #1c) General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to update its Medicaid reimbursement methodology for rehabilitation hospitals to provide more equitable reimbursement rates for each hospital relative to its total cost of services provided to Medicaid recipients.
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Modify Medicaid Criteria for Weight Loss Drugs (291 #23c) General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services (DMAS) to evaluate pharmaceutical manufacturer programs and other contracting arrangements available to state Medicaid programs that are intended to reduce the costs of glucagon-like peptide-1 (GLP-1) receptor agonists and related therapies. DMAS must project cost savings for such programs or contracting arrangements and is authorized to implement the program or arrangement with the greatest projected savings to the Medicaid program.
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Modify Medicaid Supplemental Payment for CHKD (291 #21c) General Assembly Adjustment
  This amendment modifies the formula for providing additional Medicaid supplemental payment funding to the Children's Hospital of the King's Daughters (CHKD) to stabilize funding and prevent future dramatic financial fluctuations. This supplemental payment is in lieu of Disproportionate Share Hospital (DSH) payments for which CHKD is no longer eligible after 2017 federal changes to the DSH limit. Payments remain tied to the State Plan formula for CHKD's DSH, calculated as eligible days multiplied by three times the DSH per diem for most hospitals (Type Two hospitals) not including the state's teaching hospitals (Type One hospitals). This language change would establish a funding floor at the fiscal year 2026 level of state support, with no impact on state general fund dollars.
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Modify Virginia Tech / Carilion Supplemental Payment (291 #10c) General Assembly Adjustment
  This amendment modifies the indirect medical education supplemental payment arrangement with teaching hospitals affiliated with Virginia Tech Carilion School of Medicine to allow qualified charitable contributions as a source for the non-federal share.
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Notice Practices to Applicants and Recipients of Medical Assistance (295 #4c) General Assembly Adjustment
  This amendment requires the Department of Medical Assistance Services (DMAS) and the Department of Social Services (DSS) to collaborate on methods to ensure applicants and recipients are aware of assistance for verifying medical assistance eligibility information. Language requires the agencies to make recommendations on any changes needed to assist applicants and recipients in verifying eligibility that cannot be made administratively. Language also requires DMAS and DSS to post this information on their websites and inform applicants and recipients of medical assistance on how to ensure timely receipt of information.
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Performance Measures for Non-Emergency Medical Transportation (291 #17c) General Assembly Adjustment
  This amendment adds language directing the Department of Medical Assistance Services to amend its existing contracts with Medicaid MCOs to require them to adopt performance metrics for Medicaid NEMT brokers consistent with those in the Medicaid Fee-for-Service program and report annually to the department regarding their performance. Currently, metrics collected by MCOs and reported to DMAS regarding their NEMT programs lack specificity and limit insight into the quality or performance gaps among NEMT programs operating in the Commonwealth.
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Private Teaching Hospital Medicaid Enhanced Indirect Medical Education Payments (291 #22c) General Assembly Adjustment
  This amendment adds language to allow private hospitals with smaller teaching training operations, to qualify for increased indirect medical education (IME) funding. Qualifying hospitals will have public partners capable of providing the non-federal share of the enhanced funding.
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Prospective Payment System Transition Study for STEP-VA Services (295 #2c) General Assembly Adjustment
  This amendment directs the Department of Medical Assistance Services to identify the steps necessary for Virginia to potentially transition to a prospective payment system (PPS), as designed to support the Certified Community Behavioral Health Clinic model.
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Provide Emergency Authority for H.R.1 Implementation (295 #6c) General Assembly Adjustment
  This amendment provides emergency authority to facilitate the implementation of H.R.1.
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Recognize Virginia Home Reimbursement Rate (291 #19c) General Assembly Adjustment
  This amendment clarifies the intent of the General Assembly that the Department of Medical Assistance Services recognize prior year increases authorized in the 2016 and 2020 Appropriation Acts that impact the Virginia Home, a unique nursing facility serving a resident population of individuals with quadriplegia, traumatic brain injury, multiple sclerosis, paraplegia, or cerebral palsy.
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Remove Language on Hospital Contracts with Medicaid MCOs (291 #5c) General Assembly Adjustment
  This amendment removes the provision contained in the introduced budget requiring hospitals to contract with all Medicaid managed care organizations to continue to be eligible for the provider rate assessment payments and corrects the reference to the item which authorizes the private hospital enhanced payments.
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Reporting on Rural Health Transformation Program (296 #1c) General Assembly Adjustment
  This amendment adds a reporting requirement for the Rural Health Transformation Program.


p3_bullets - Official Enacted Budget - 08-18-2026 03:09:37