The 2018 Executive Budget Document
Governor McAuliffe's Proposed Budget for the 2018-2020 Biennum
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Released on December 18, 2017 
 
Department of Medical Assistance Services [602]
Secretarial Area: Health and Human Resources
Operating Budget Summary
This table shows the Governor's proposed budget for the next two years and the agency's official budget for the previous six years.
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Biennium Fiscal Year Source GF NGF Total
2012-2014 2013 Chapter 1, 2014 Acts of Assembly $3,547,761,312 $4,525,123,550 $8,072,884,862
2012-2014 2014 Chapter 1, 2014 Acts of Assembly $3,669,406,166 $4,829,310,906 $8,498,717,072
2014-2016 2015 Chapter 732, 2016 Acts of Assembly $3,846,847,641 $4,786,951,421 $8,633,799,062
2014-2016 2016 Chapter 732, 2016 Acts of Assembly $4,266,731,052 $5,073,691,875 $9,340,422,927
2016-2018 2017 Chapter 1, 2018 Acts of Assembly $4,450,859,097 $5,472,509,199 $9,923,368,296
2016-2018 2018 Chapter 1, 2018 Acts of Assembly $4,785,782,724 $5,892,680,250 $10,678,462,974
2018-2020 2019 Governor's Proposed Budget $4,801,895,641 $6,923,795,379 $11,725,691,020
    Base Budget $4,729,698,510 $5,623,286,311 $10,352,984,821
    Addenda (Changes to the Base) $72,197,131 $1,300,509,068 $1,372,706,199
2018-2020 2020 Governor's Proposed Budget $4,981,573,065 $8,428,212,832 $13,409,785,897
    Base Budget $4,729,698,510 $5,623,286,311 $10,352,984,821
    Addenda (Changes to the Base) $251,874,555 $2,804,926,521 $3,056,801,076
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
2012-2014 2013 Chapter 1, 2014 Acts of Assembly 183.82 212.18 396.00
2012-2014 2014 Chapter 1, 2014 Acts of Assembly 198.32 226.68 425.00
2014-2016 2015 Chapter 732, 2016 Acts of Assembly 210.37 216.63 427.00
2014-2016 2016 Chapter 732, 2016 Acts of Assembly 225.02 234.98 460.00
2016-2018 2017 Chapter 1, 2018 Acts of Assembly 232.02 241.98 474.00
2016-2018 2018 Chapter 1, 2018 Acts of Assembly 240.02 249.98 490.00
2018-2020 2019 Proposed Positions 248.52 258.48 507.00
    Base Budget 240.02 249.98 490.00
    Addenda (Changes to the Base) 17.50 9.50 27.00
2012-2014 2020 Proposed Positions 248.52 258.48 507.00
    Base Budget 240.02 249.98 490.00
    Addenda (Changes to the Base) 8.50 8.50 17.00
Operating Budget Addenda (in order of greatest impact)
•
Provide health care coverage to the uninsured Decision Package
  Authorizes the expansion of Medicaid on October 1, 2018, to non-elderly adults with incomes up to 133 percent of the federal poverty level. This action results in over 300,000 Virginians gaining access to health care. This coverage expansion will reduce indigent care costs for hospitals across the Commonwealth, resulting in improvements to their financial condition, especially for rural hospitals. As such, the cost of this expansion will be covered by an assessment on the net patient revenue of private acute care hospitals operating in Virginia. This proposed expansion of Medicaid will allow Virginia to achieve significant savings as new Medicaid funding will supplant state-supported indigent care costs, services provided by Community Services Boards, and inpatient hospital costs for incarcerated individuals. The estimated general fund savings to the Commonwealth is approximately $152.0 million in FY 2019 and $269.7 million in FY 2020. CHAR(13) + CHAR(10)
 
  FY 2019 FY 2020
General Fund ($120,384,883) ($221,410,214)
Nongeneral Fund $926,114,992 $2,236,379,476
Positions 15.00 15.00
•
Fund Medicaid utilization and inflation Decision Package
  Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent forecast expenditures.
 
  FY 2019 FY 2020
General Fund $199,450,674 $384,421,932
Nongeneral Fund $334,394,964 $498,099,289
•
Add waiver slots as required by the Department of Justice settlement agreement Decision Package
  Adds a total of 825 new waiver slots to the Community Living (CL) and Family and Individual Supports (FIS) waivers over the course of the biennium. These slots are mandated by the settlement agreement with the U.S. Department of Justice and include 70 slots for individuals transitioning out of facilities (35 in the each year), 75 slots to address the FIS waiver waitlist (25 in the first year and 50 in the second year), and 680 slots to address the CL waiver waitlist (325 in the first year and 355 in the second year).
 
  FY 2019 FY 2020
General Fund $14,504,043 $30,515,895
Nongeneral Fund $14,504,043 $30,515,895
•
Fund Family Access to Medical Insurance Security utilization and inflation Decision Package
  Adjusts funding for utilization and inflation in the Family Access to Medical Insurance Security (FAMIS) program based on the most recent forecast of expenditures. Funding assumes that current enhanced federal match (88 percent) is maintained for federal fiscal years 2018 and 2019. In federal fiscal year 2020, it is expected that the federal match rate for Virginia will drop to 76.5 percent.
 
  FY 2019 FY 2020
General Fund $3,849,858 $23,399,128
Nongeneral Fund $28,232,295 $19,253,975
•
Correct Medicaid forecast to account for ACA tax and CSA spending Decision Package
  Amends funding provided, in a separate package, for the November 2017 forecast of Medicaid expenditures to fully fund the cost of a federal tax imposed on health plans. In addition, funding is removed to account for an annual transfer of general fund from the Children's Services Act (CSA) to support services provided to CSA children.
 
  FY 2019 FY 2020
General Fund ($22,426,441) $14,377,085
Nongeneral Fund ($22,426,441) $14,377,085
•
Rebase training center budgets to reflect anticipated closures Decision Package
  Adjusts the budget for state training center reimbursements to account for the on-going facility closure costs and savings resulting from compliance with the Department of Justice settlement agreement. This action represents the projected training center savings, which are based on the anticipated discharge schedules for the Central Virginia Training Center (CVTC) and Southwestern Virginia Training Center (SWVTC) and the associated direct and indirect costs. There is a companion amendment included in the Department of Behavioral Health and Developmental Services training center Item to account for costs not reimbursable through Medicaid.
 
  FY 2019 FY 2020
General Fund ($10,547,486) ($17,036,146)
Nongeneral Fund ($10,547,486) ($17,036,146)
•
Adjust Health Care Fund appropriation Decision Package
  Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Tobacco taxes are projected to decrease by $10.1 million in FY 2019 and $10.8 million in FY 2020 based on the Department of Taxation's revised forecast. Conversely, Medicaid recoveries are expected to increase by $22.3 million in FY 2019 and $17.3 million in FY 2020. Since the Health Care Fund is used as state match for Medicaid, any change in revenue to the fund impacts general fund support for Medicaid.
 
  FY 2019 FY 2020
General Fund ($12,220,660) ($6,520,660)
Nongeneral Fund $12,220,660 $6,520,660
•
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. Funding assumes that current enhanced federal match (88 percent) is maintained for federal fiscal years 2018 and 2019. In federal fiscal year 2020, it is expected that the federal match rate for Virginia will drop to 76.5 percent.
 
  FY 2019 FY 2020
General Fund $1,921,446 $16,615,995
Nongeneral Fund $14,090,604 $4,571,074
•
Adjust appropriation to reflect anticipated grant revenue Decision Package
  Adjusts federal appropriation to reflect anticipated grant revenue from the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program. Entirely supported with federal dollars, the EHR incentive program is in its final program years with payments ending in 2021.
 
  FY 2019 FY 2020
Nongeneral Fund ($16,000,000) ($16,000,000)
•
Increase rates for consumer directed personal care, respite, and companion services Decision Package
  Increases rates for consumer directed personal, respite, and companion care services by two percent in the home and community based services waivers and Early Periodic Screening, and Diagnosis and Treatment program (EPSDT) program to cover provider expenses.
 
  FY 2019 FY 2020
General Fund $4,773,196 $5,055,102
Nongeneral Fund $4,773,196 $5,055,102
•
Allow consumer-directed attendants to receive overtime pay for up to 56 hours Decision Package
  Authorizes the Department of Medical Assistance Services (DMAS), beginning July 1, 2019, to pay overtime compensation to attendants who are providing care under the consumer-directed service option in the Medicaid waivers. This amendment replaces current language prohibiting overtime hours being worked by consumer-directed attendants with language that allows DMAS to pay time and a half for up to 16 hours for a single attendant who works more than 40 hours per week.
 
  FY 2019 FY 2020
General Fund $0 $9,609,223
Nongeneral Fund $0 $9,609,223
•
Provide funding for Cover Virginia Call Center Decision Package
  Funds the anticipated increased costs associated with re-procuring the Cover Virginia Call Center. The current Cover Virginia contract, which includes a statewide call center, MAGI eligibility determination unit, and the GAP program unit, ends June 30, 2018. DMAS expects to request an extension of this contract for the period July 1, 2018 for one additional year ending June 30, 2019, the maximum allowable extension. The funding provided in this package will ensure continuity of operations through the new performance period.
 
  FY 2019 FY 2020
General Fund $3,750,000 $1,125,000
Nongeneral Fund $6,250,000 $3,375,000
•
Fund medical services for involuntary mental commitments Decision Package
  Increases funding for the cost of hospital and physician services for persons subject to an involuntary mental commitment. The most recent forecast of expenditures projects higher costs than previously estimated.
 
  FY 2019 FY 2020
General Fund $3,022,906 $3,935,262
•
Adjust appropriation for the centrally funded three percent salary increase for state employees Base Budget Adjustment
  Adjusts appropriation for the three percent salary increase for state employees budgeted in Central Appropriations, Item 475 X. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund $1,694,025 $1,694,025
Nongeneral Fund $1,749,678 $1,749,678
•
Fund Medicaid cost of adopting same day access in remaining community service boards Decision Package
  Covers the Medicaid costs associated with completing the implementation of same day access at all Community Service Boards (CSB) effective July 1, 2019. The budget adopted by the 2016 General Assembly included funds to cover the Medicaid cost of providing same day access at 18 of the 40 CSBs in Virginia beginning July 1, 2017. This funding will support the costs in the remaining 22 CSBs.
 
  FY 2019 FY 2020
General Fund $1,600,000 $1,600,000
Nongeneral Fund $1,600,000 $1,600,000
•
Adjust appropriation for centrally funded health insurance costs Base Budget Adjustment
  Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 475 G. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund $1,469,264 $1,469,264
Nongeneral Fund $1,506,557 $1,506,557
•
Add reserve waiver slots Decision Package
  Funds 50 community living (CL) waiver slots (25 in each year) that will be held as reserve capacity by the Department of Behavioral Health and Disability Services (DBHDS). This capacity will allow DBHDS to address unanticipated emergency situations, such as accommodating community transition of institutionalized individuals, transitioning between waivers, and serving individuals in a crisis situation.
 
  FY 2019 FY 2020
General Fund $937,238 $1,874,475
Nongeneral Fund $937,238 $1,874,475
•
Fund federally required independent External Quality Review Organization (EQRO) activities Decision Package
  Funds a contract with an independent External Quality Review Organization (EQRO) to conduct an external quality review of the department's contracted managed care organizations (MCO). EQRO activities include the analysis and evaluation of aggregated information on quality, timeliness, and access to the health care services that MCOs furnish to Medicaid recipients. This package also supports an audit of each MCO's network to ensure enrollees have adequate access to services. This funding ensures that the Commonwealth’s managed care programs (Commonwealth Coordinated Care Plus and Medallion 4.0) are fully compliant with final federal regulations.
 
  FY 2019 FY 2020
General Fund $301,755 $570,449
Nongeneral Fund $905,266 $1,711,348
•
Reduce appropriation to reflect the impact of DSH cuts on state behavioral health facilities Decision Package
  Reduces the appropriation (general fund and federal) that is used to provide Disproportionate Share Hospital (DSH) payments to two behavioral health facilities (Piedmont Geriatric Hospital and Catawba Hospital) operated by the Department of Behavioral Health and Developmental Services. DSH payments are made to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. The Patient Protection and Affordable Care Act (ACA, P. L. 111-148 as amended) reduces DSH funding to all states beginning in federal FY 2018 (cuts were originally supposed to begin in FY 2014 but have been delayed). As such, it is expected that the payments (total funds) to Piedmont and Catawba will be reduced $907,820 in FY 2019 and $1,270,948 in FY 2020 (half of these amounts are general fund).
 
  FY 2019 FY 2020
General Fund ($453,910) ($635,474)
Nongeneral Fund ($453,910) ($635,474)
•
Provide training for consumer-directed attendants Decision Package
  Funds training for consumer-directed attendants who provide personal assistance, respite, and companion services.
 
  FY 2019 FY 2020
General Fund $500,000 $500,000
Nongeneral Fund $500,000 $500,000
•
Adjust appropriation for the centrally funded changes in agency information technology costs Base Budget Adjustment
  Adjusts appropriation for changes in information technology and telecommunications usage budgeted in Central Appropriations, Item 476 G. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund $73,725 $73,725
Nongeneral Fund $658,403 $658,403
•
Increase use of civil money penalty funds Decision Package
  Appropriates revenue generated from Civil Money Penalties (CMP) to support additional activities as approved by the Centers for Medicare and Medicaid Services. CMPs are sanctions collected from nursing facilities for being out of compliance with federal long term care requirements. A portion of these penalties are retained by Virginia to address emergency situations and support activities that benefit nursing facility residents.
 
  FY 2019 FY 2020
Nongeneral Fund $700,000 $700,000
•
Adjust appropriation for centrally funded retirement rate changes Base Budget Adjustment
  Adjusts appropriation for the employer’s share of health insurance premiums budgeted in Central Appropriations, Item 475 G. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund ($331,956) ($331,956)
Nongeneral Fund ($342,860) ($342,860)
•
Adjust appropriation for the centrally funded two percent salary increase for high turnover positions Base Budget Adjustment
  Adjusts appropriation for the two percent salary increase for state employees in high turnover job roles budgeted in Central Appropriations, Item 475 BB. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund $255,956 $255,956
Nongeneral Fund $255,956 $255,956
•
Provide eye care services to children in certain schools Decision Package
  Authorizes the agency to partner with Vision to Learn, a non-profit organization, to provide vision exams and corrective lenses and frames to school age children enrolled in Title I schools where at least 51 percent of the student body qualifies for free or reduced lunch. The agency is further authorized to use local public and private contributions to match federal funds through the Children’s Health Insurance Program (CHIP) Health Services Initiative.
 
  FY 2019 FY 2020
Nongeneral Fund $336,096 $336,096
•
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 476 J. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund $141,447 $141,447
Nongeneral Fund $157,955 $157,955
•
Strengthen data security and compliance processes Decision Package
  Provides funding to address data security weaknesses by adding two new positions with experience in risk management, encryption key management, intrusion protection and detection, and vulnerability scanning.
 
  FY 2019 FY 2020
General Fund $138,087 $138,087
Nongeneral Fund $138,087 $138,087
Positions 2.00 2.00
•
Adjust appropriation for centrally funded workers’ compensation premium changes Base Budget Adjustment
  Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 475 V. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund ($133,860) ($133,860)
Nongeneral Fund ($134,245) ($134,245)
•
Replace lost federal match for information technology staff Decision Package
  Replaces general fund captured as part of a prior savings action that assumed a higher federal match for information technology staff working on the Medicaid Enterprise System replacement. Through an Advanced Planning Document approved by CMS, staff costs for certain activities related to the re-procurement, including evaluating proposals, developing requirements, and program management, are eligible for a 90 percent federal match rate. However, this increased match rate will discontinue as the new system enters operational status in FY 2020. After implementation, the match rate will revert to the 50 percent standard Medicaid rate for the hours spent on eligible activities.
 
  FY 2019 FY 2020
General Fund $0 $250,000
Nongeneral Fund $0 ($250,000)
•
Adjust appropriation for centrally funded state employee other post-employment benefit rate changes Base Budget Adjustment
  Adjusts appropriation for changes in state employee other post-employment benefit rates budgeted in Central Appropriations, Item 475 K. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund $109,138 $109,138
Nongeneral Fund $112,723 $112,723
•
Fund increased cost of third party liability (TPL) verifications Decision Package
  Provides funds to cover the increased cost of performing approximately 28,000 TPL verifications annually. In addition, the package provides funding to conduct approximately 2,000 additional verifications per year as well as 675 Medicare verifications.
 
  FY 2019 FY 2020
General Fund $104,175 $104,175
Nongeneral Fund $104,175 $104,175
•
Fund mandated evaluation of the Governor’s Access Program (GAP) waiver Decision Package
  Supports a federally required independent evaluation of the GAP waiver. Addiction and Recovery Treatment Services (ARTS) residential and partial hospitalization services were added to the GAP Waiver on October 1, 2017 as directed by the 2017 Appropriations Act. The Centers for Medicare and Medicaid Services are requiring an independent evaluation of the impact of the entire GAP waiver be conducted.
 
  FY 2019 FY 2020
General Fund $85,000 $85,000
Nongeneral Fund $85,000 $85,000
•
Increase funding for children's enrollment services contract Decision Package
  Provides additional funding to contract with the Virginia Health Care Foundation (VHCF) to increase and retain enrollment in Virginia’s FAMIS programs. The contract will support outreach and enrollment assistance activities that will be conducted by outreach workers and VHCF staff as well as training and technical assistance which includes, but is not limited to, SignUpNow trainings and newsletters and other effective methods, tools, and activities.
 
  FY 2019 FY 2020
General Fund $11,280 $19,388
Nongeneral Fund $82,720 $74,612
•
Adjust appropriation for centrally funded internal service fund charges for the Personnel Management Information System Base Budget Adjustment
  Adjusts appropriation for the Personnel Management Information System internal service fund charges budgeted in Central Appropriations, Item 476 O. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund $4,178 $4,178
Nongeneral Fund $4,684 $4,684
•
Adjust appropriation for centrally funded changes in Cardinal charges Base Budget Adjustment
  Adjusts appropriation for the reduction in Cardinal charges budgeted in Central Appropriations, Item 476 L. of Chapter 836, 2017 Acts of Assembly.
 
  FY 2019 FY 2020
General Fund ($1,064) ($1,064)
Nongeneral Fund ($1,282) ($1,282)
•
Provide notice of state plan and waiver amendments Decision Package
  Adds language requiring the agency to provide the Department of Planning and Budget with advance notice of any changes to the state plan or waivers.
•
Add language to specify medical residencies awards Decision Package
  Adds language to specify which hospitals have been awarded the remaining ten graduate medical residency slots from the initial cohort currently funded in the Act.
•
Ensure the continued availability of Children's Services Act (CSA) payment data Decision Package
  Requires the continued collection of local matching dollars associated with payments for Medicaid eligible services provided to children through the Children’s Services Act (CSA). Beginning December 2018, behavioral health services provided to CSA children, including residential services and foster care case management, will be covered under managed care instead of fee-for-service. In the current environment, the Department of Medical Assistance Services (DMAS) sends CSA data on a monthly basis which CSA uses to recover mandated local matching dollars. This language is needed to ensure that DMAS has the ability to continue to send CSA the data necessary to recover local dollars.
•
Update eligibility performance management program Decision Package
  Adds language that requires the Departments of Medical Assistance Services (DMAS) and Social Services to report data that demonstrates the accuracy, efficiency, compliance, quality of customer service, and timeliness of determining eligibility for Medicaid, Children's Health Insurance Program (CHIP) and Governor’s Access Program. Furthermore, DMAS is required to maintain a public dashboard of eligibility performance on its website.
•
Move appropriation to reflect agency operations Decision Package
  Transfers appropriation between service areas in the agency's administrative program to reflect current operations. Specifically, all appropriation in the Information Technology Services (49902) service area is moved to the General Management and Direction (49901) service area. This action reduces redundancy and eases the management of balances at year end.


pdocagy2014 - Executive Budget Document Agency Details - 06-30-2025 19:22:37