The 2020 Executive Budget Document
Governor Northam's Proposed Budget for the 2020-2022 Biennum
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Released on December 17, 2019 
 
Department of Medical Assistance Services [602]
Secretarial Area: Health and Human Resources
Operating Budget Summary
This table shows the Governor's proposed budget for the next two years and the agency's official budget for the previous six years.
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Biennium Fiscal Year Source GF NGF Total
2014-2016 2015 Chapter 732, 2016 Acts of Assembly $3,846,847,641 $4,786,951,421 $8,633,799,062
2014-2016 2016 Chapter 732, 2016 Acts of Assembly $4,266,731,052 $5,073,691,875 $9,340,422,927
2016-2018 2017 Chapter 1, 2018 Acts of Assembly $4,450,859,097 $5,472,509,199 $9,923,368,296
2016-2018 2018 Chapter 1, 2018 Acts of Assembly $4,785,782,724 $5,892,680,250 $10,678,462,974
2018-2020 2019 Chapter 1283, 2020 Acts of Assembly $5,008,158,914 $7,594,157,772 $12,602,316,686
2018-2020 2020 Chapter 1283, 2020 Acts of Assembly $4,899,537,379 $10,228,886,509 $15,128,423,888
2020-2022 2021 Governor's Proposed Budget $5,323,216,579 $11,430,545,452 $16,753,762,031
    Base Budget $5,159,981,592 $10,545,577,374 $15,705,558,966
    Addenda (Changes to the Base) $163,234,987 $884,968,078 $1,048,203,065
2020-2022 2022 Governor's Proposed Budget $5,685,624,415 $12,199,523,555 $17,885,147,970
    Base Budget $5,159,981,592 $10,545,577,374 $15,705,558,966
    Addenda (Changes to the Base) $525,642,823 $1,653,946,181 $2,179,589,004
Positions Budget Summary
Biennium Fiscal Year Source GF NGF Total
2014-2016 2015 Chapter 732, 2016 Acts of Assembly 210.37 216.63 427.00
2014-2016 2016 Chapter 732, 2016 Acts of Assembly 225.02 234.98 460.00
2016-2018 2017 Chapter 1, 2018 Acts of Assembly 232.02 241.98 474.00
2016-2018 2018 Chapter 1, 2018 Acts of Assembly 240.02 249.98 490.00
2018-2020 2019 Chapter 1283, 2020 Acts of Assembly 257.52 273.48 531.00
2018-2020 2020 Chapter 1283, 2020 Acts of Assembly 259.52 275.48 535.00
2020-2022 2021 Proposed Positions 260.02 276.98 537.00
    Base Budget 259.52 275.48 535.00
    Addenda (Changes to the Base) 0.50 (5.50) (5.00)
2012-2014 2022 Proposed Positions 260.02 276.98 537.00
    Base Budget 259.52 275.48 535.00
    Addenda (Changes to the Base) 0.50 1.50 2.00
Operating Budget Addenda (in order of greatest impact)
•
Fund Medicaid utilization and inflation Decision Package
  Provides funding for the cost of Medicaid utilization and inflation as estimated in the most recent expenditure forecast.
 
  FY 2021 FY 2022
General Fund $174,441,079 $500,534,467
Nongeneral Fund $744,289,657 $1,443,022,309
•
Adjust Health Care Fund appropriation Decision Package
  Modifies the appropriation for the Virginia Health Care Fund to reflect the latest revenue estimates. Revenue from the Master Settlement Agreement is expected to decline by $10.1 million in FY 2021 and $10.6 million in FY 2022. Tobacco taxes are projected to increase by $117.2 million in 2021 and $124.3 million in 2022 based on the Department of Taxation's revised forecast, which includes revenue from a proposed increase to the cigarette tax. Prior year Medicaid recovery estimates are expected to decrease by $1.5 million in FY 2021 and then grow by $4.1 million in FY 2022. Since the fund is used as state match for Medicaid, any change in revenue to the fund impacts general fund support for Medicaid.
 
  FY 2021 FY 2022
General Fund ($105,603,262) ($117,786,979)
Nongeneral Fund $105,603,262 $117,786,979
•
Fund Family Access to Medical Insurance Security (FAMIS) utilization and inflation Decision Package
  Adjusts funding for the FAMIS program to reflect the latest forecast of expenditures. The general fund amount reflects the loss of enhanced federal matching dollars as the match rate for CHIP programs decreased from 76.5 percent to 65 percent in federal FY 2021. In addition to replacing lost federal revenue, FAMIS costs are being driven by continued enrollment growth and higher managed care rates.
 
  FY 2021 FY 2022
General Fund $33,985,435 $46,198,275
Nongeneral Fund ($9,424,768) ($6,773,894)
•
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. Children between the ages of 6 and 19, with family income from 100 to 133 percent of the federal poverty level, are eligible for this program. The general fund amount reflects the loss of enhanced federal matching dollars as the match rate for CHIP programs decreased from 76.5 percent to 65 percent in federal FY 2021. In addition to replacing lost federal revenue, costs are being driven by continued enrollment growth and higher managed care rates.
 
  FY 2021 FY 2022
General Fund $27,561,556 $40,780,131
Nongeneral Fund ($13,464,366) ($7,381,536)
•
Increase number of Developmental Disability Waiver slots Decision Package
  Adds a total of 1,135 new waiver slots to the Community Living (CL) and Family and Individual Supports (FIS) waivers over the course of the biennium. These slots include 835 slots to address the FIS waiver waitlist (635 in the first year and 200 in the second year), 200 slots to address the CL waiver waitlist (125 in the first year and 75 in the second year), 50 slots for individuals transitioning out of facilities (25 in each year), and 50 emergency slots (25 in each year).
 
  FY 2021 FY 2022
General Fund $16,985,260 $24,828,805
Nongeneral Fund $16,985,260 $24,828,805
•
Encourage private acute care hospitals to accept more temporary detention orders Decision Package
  Increases the provider rate assessment charged to private acute care hospitals by $16.3 million beginning in FY 2021. This additional revenue will be used to provide incentive DSH payments to support increased temporary detention order (TDO) utilization in private acute care hospitals. In addition, the Departments of Medical Assistance Services and Behavioral Health and Developmental Services are each provided funding to support a position that will administer this initiative.
 
  FY 2021 FY 2022
Nongeneral Fund $32,523,924 $32,523,924
Positions 1.00 1.00
•
Fund home visiting services Decision Package
  Implements a home visiting benefit for pregnant and post-partum women at risk of poor health outcomes effective July 1, 2021. Prior to implementation, DMAS shall engage all relevant stakeholders in the development of the benefit and gaining the necessary federal approvals.
 
  FY 2021 FY 2022
General Fund $1,054,300 $11,750,159
Nongeneral Fund $3,514,556 $34,216,923
•
Redesign COMPASS 1115 waiver Decision Package
  Adjusts appropriation and language to restructure the COMPASS 1115 waiver to include only a targeted supportive employment and housing benefit.
 
  FY 2021 FY 2022
Nongeneral Fund ($17,265,286) ($17,265,286)
•
Adjust training center budgets to reflect anticipated costs 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 2021 FY 2022
General Fund ($4,761,147) ($13,898,647)
Nongeneral Fund ($2,996,518) ($12,134,018)
•
Enhance behavioral health services Decision Package
  Provides funding and authority to establish and implement changes to service definitions, prior authorization and utilization review criteria, provider qualifications, and reimbursement rates for select Medicaid behavioral health services.
 
  FY 2021 FY 2022
General Fund $3,028,038 $10,273,553
Nongeneral Fund $4,127,378 $14,070,322
•
Provide care coordination prior to release from incarceration Decision Package
  Provides funding and authority to offer care coordination services to individuals who are Medicaid eligible 30 days prior to release from incarceration.
 
  FY 2021 FY 2022
General Fund $347,803 $465,440
Nongeneral Fund $11,398,558 $16,404,809
•
Adjust appropriation to reflect agency operations Decision Package
  Moves appropriation and positions between service areas and fund details to ensure that all agency services are properly budgeted. This includes the transfer of $3.0 million general fund in FY 2021 and $3.6 million general fund in FY 2022 within administrative service areas to account for the reduction of federal match for CHIP programs. In addition, nongeneral fund appropriation is being removed, from the federal Medicaid Incentive Program and Vision to Learn, to account for anticipated operations.
 
  FY 2021 FY 2022
Nongeneral Fund ($9,070,265) ($12,580,265)
•
Eliminate 40 quarter work requirement for legal permanent residents Decision Package
  Eliminates the 40-quarter work requirement for lawful permanent residents (LPRs). The current requirement prevents otherwise eligible individuals from receiving needed care and increases unnecessary and expensive emergency care.
 
  FY 2021 FY 2022
General Fund $1,172,091 $3,289,890
Nongeneral Fund $6,519,419 $9,548,955
•
Increase Developmental Disability (DD) waiver rates Decision Package
  Increases provider payment rates for services delivered through the Developmental Disability (DD) waivers. The rate increase will apply to the following services: Independent Living Supports Supported Living, In-home Support Services, Group Supported Employment, Workplace Assistance, Community Engagement, Community Coaching, and Therapeutic Consultation.
 
  FY 2021 FY 2022
General Fund $3,639,663 $3,748,853
Nongeneral Fund $3,639,663 $3,748,853
•
Increase mental health provider rates Decision Package
  Raises rates for psychiatric services by 14.7 percent. This action increases rates to the equivalent of 110 percent of the 2019 Medicare rates for these services.
 
  FY 2021 FY 2022
General Fund $2,374,698 $2,458,479
Nongeneral Fund $4,370,186 $4,488,751
•
Fund Managed Care Contract Changes Decision Package
  Provides funding and authority to include a number of changes to the 2020-2021 managed care contracts.
 
  FY 2021 FY 2022
General Fund $2,226,600 $2,428,350
Nongeneral Fund $2,226,600 $2,428,350
•
Extend FAMIS MOMS' postpartum coverage to 12 months Decision Package
  Extends postpartum coverage for FAMIS MOMS from 60 days to 12 months. Currently, women up to 205 percent of the federal poverty level are eligible for coverage during their pregnancy and up to 60 days postpartum from the delivery date on file.
 
  FY 2021 FY 2022
General Fund $1,114,936 $2,116,376
Nongeneral Fund $2,120,272 $3,930,412
•
Restore funding for obesity and tobacco prevention Decision Package
  Removes language that sets the percentage of Master Settlement Agreement (MSA) revenue deposited into the VIrginia Health Care Fund at 41.5 percent. As such, MSA deposits to the VHCF will revert to 40 percent as directed in the Code of Virginia. In addition, language redirecting MSA Strategic Contribution Payments is also removed. This action restores approximately $1.7 million annually to the Virginia Foundation for Healthy Youth and requires that $1.7 million general fund be restored to the VHCF to replace the revenue that would have been used as Medicaid matching dollars.
 
  FY 2021 FY 2022
General Fund $1,734,940 $1,716,867
Nongeneral Fund ($1,734,940) ($1,716,867)
•
Fund costs of Medicaid-reimbursable STEP-VA services Decision Package
  Provides funds for the Medicaid costs associated with the implementation of STEP-VA behavioral health services.
 
  FY 2021 FY 2022
General Fund $486,951 $2,293,826
Nongeneral Fund $486,951 $2,293,826
•
Expand opioid treatment services Decision Package
  Provides funding to expand the Preferred Office-Based Opioid Treatment (OBOT) model to allow for all Substance Use Disorders (SUD) covered in the Addiction and Recovery Treatment Services (ARTS) benefit. The Preferred OBOT is a community-based, high-touch, evidence-based model of care for individuals with addiction. Virginia Medicaid currently limits service reimbursement in the Preferred OBOT to individuals with Opioid Use Disorder (OUD). Those with a primary diagnosis of SUD for a non-opioid such as alcohol, cocaine, or methamphetamine are not currently covered in the Preferred OBOT model.
 
  FY 2021 FY 2022
General Fund $421,476 $1,273,633
Nongeneral Fund $620,156 $1,873,300
•
Adjust appropriation for centrally funded 2.75 percent salary increase for state employees Base Budget Adjustment
  Adjusts appropriation for the 2.75 percent salary increase for state employees budgeted in Central Appropriations, Item 474 T. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund $1,084,758 $1,084,758
•
Allow FAMIS MOMS to access substance use disorder treatment in an institution for mental disease Decision Package
  Provides funding to allow FAMIS MOMS to access medically necessary treatment for a substance use disorder in an Institution for Mental Diseases (IMD) under the Addiction and Recovery Treatment Services (ARTS) waiver.
 
  FY 2021 FY 2022
General Fund $307,500 $356,775
Nongeneral Fund $626,900 $662,550
•
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 475 G. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund $812,585 $812,585
•
Adjust appropriation for centrally funded 2.25 percent merit-based salary increase for state employees Base Budget Adjustment
  Adjusts appropriation for the 2.25 percent merit-based salary increase for state employees budgeted in Central Appropriations, Item 474 V. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund $765,504 $765,504
•
Reduce contract spending Decision Package
  Accounts for lower spending on support contracts as the agency shifts to lower cost alternatives.
 
  FY 2021 FY 2022
General Fund ($302,787) ($302,787)
Nongeneral Fund ($302,787) ($302,787)
•
Implement episodic payment models for certain conditions Decision Package
  Requires the development and implementation of episode-based payment models for maternity care, asthma, and congestive heart failure. The department shall develop these models with a goal of reducing costs and improving the quality of care for Medicaid members.
 
  FY 2021 FY 2022
General Fund $151,915 $249,415
Nongeneral Fund $174,266 $271,766
Positions 1.00 1.00
•
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 474 G. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund $374,693 $374,693
•
Adjust appropriation for centrally funded workers’ compensation premium changes Base Budget Adjustment
  Adjusts appropriation for workers’ compensation premiums budgeted in Central Appropriations, Item 474 R. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund ($210,522) ($210,522)
•
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 475 M. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund $51,700 $51,700
•
Adjust appropriation for centrally funded state employee other post-employment benefit rate changes Base Budget Adjustment
  Adjusts appropriation for changes to state employee other post-employment benefit rates budgeted in Central Appropriations, Item 474 K. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund ($9,537) ($9,537)
•
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 474 H. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund $9,535 $9,535
•
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 475 L. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund ($3,765) ($3,765)
•
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 475 K. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund ($3,520) ($3,520)
•
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 475 O. of Chapter 854, 2019 Acts of Assembly.
 
  FY 2021 FY 2022
General Fund ($3,489) ($3,489)
•
Offset lost federal revenue for Children's Hospital of The King's Daughters (CHKD) Decision Package
  Authorizes the department to create additional hospital supplemental payments for CHKD to replace payments that have been reduced due to the federal regulation on the definition of uncompensated care costs effective June 2, 2017. These new payments will equal what would have been paid to CHKD under the current disproportionate share hospital (DSH) formula.
•
Adjust Medicaid forecasting process Decision Package
  Updates the Medicaid forecasting process and deliverables to improve transparency and enhance external oversight.
•
Clarify provider assessment language Decision Package
  Updates language for both the coverage and rate provider assessments. These changes conform the Act language to current practice and make technical adjustments to improve the efficiency of both programs. None of the changes will have any impact on the overall amount of revenue collected or how funds are expended.


pdocagy2014 - Executive Budget Document Agency Details - 06-08-2025 01:24:48