The 2026 Executive Budget Document
Governor Youngkin's Proposed Budget for the 2026-2028 Biennial Budget
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Released on December 17, 2025 
 
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 725, 2025 Acts of Assembly $7,209,890,810 $19,062,899,817 $26,272,790,627
2024-2026 2026 Chapter 725, 2025 Acts of Assembly $7,622,621,275 $19,926,298,195 $27,548,919,470
2026-2028 2027 Governor's Proposed Budget $8,539,489,233 $21,905,822,551 $30,445,311,784
    Base Budget $7,622,621,275 $19,926,298,195 $27,548,919,470
    Addenda (Changes to the Base) $916,867,958 $1,979,524,356 $2,896,392,314
2026-2028 2028 Governor's Proposed Budget $9,073,924,572 $22,952,042,280 $32,025,966,852
    Base Budget $7,622,621,275 $19,926,298,195 $27,548,919,470
    Addenda (Changes to the Base) $1,451,303,297 $3,025,744,085 $4,477,047,382
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 725, 2025 Acts of Assembly 274.02 292.98 567.00
2024-2026 2026 Chapter 725, 2025 Acts of Assembly 276.52 295.48 572.00
2026-2028 2027 Proposed Positions 278.02 318.98 597.00
    Base Budget 276.52 295.48 572.00
    Addenda (Changes to the Base) 1.50 23.50 25.00
2012-2014 2028 Proposed Positions 278.02 321.98 600.00
    Base Budget 276.52 295.48 572.00
    Addenda (Changes to the Base) 1.50 26.50 28.00
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 as projected by the Department of Medical Assistance Services.
 
  FY 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
General Fund ($21,038,424) ($23,807,608)
Nongeneral Fund ($22,868,263) ($25,811,423)
•
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 2027 FY 2028
General Fund ($6,858,938) ($6,858,938)
Nongeneral Fund ($39,829,380) ($39,829,380)
•
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 2027 FY 2028
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 2027 FY 2028
Nongeneral Fund $35,551,741 $35,551,741
•
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 2027 FY 2028
General Fund ($10,000,000) ($10,000,000)
Nongeneral Fund ($11,650,000) ($11,650,000)
•
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
General Fund ($669,055) ($1,331,587)
Nongeneral Fund ($4,055,617) ($7,648,975)
•
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 2027 FY 2028
General Fund $2,420,036 $2,420,036
Nongeneral Fund $2,110,998 $2,110,998
•
Streamline service facilitation Decision Package
  Incorporates service facilitation into the statewide service broker contract.
 
  FY 2027 FY 2028
General Fund ($2,130,903) ($2,228,737)
Nongeneral Fund ($2,165,111) ($2,261,653)
•
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 2027 FY 2028
General Fund ($1,250,000) ($1,250,000)
Nongeneral Fund ($1,250,000) ($1,250,000)
•
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
General Fund ($1,131,154) ($2,052,918)
•
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 2027 FY 2028
General Fund $672,776 $672,776
Nongeneral Fund $478,875 $478,875
•
Adjust federal appropriation for state facilities Decision Package
  Adjusts state facility appropriation to reflect the latest federal medical assistance percentage.
 
  FY 2027 FY 2028
Nongeneral Fund ($1,043,672) ($1,148,340)
•
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
General Fund $26,039 $26,039
Nongeneral Fund $76,341 $76,341
•
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 2027 FY 2028
Nongeneral Fund $100,000 $100,000
•
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
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 2027 FY 2028
General Fund $451 $451
Nongeneral Fund $451 $451
•
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.
•
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.
•
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.
•
Delay implementation of redesigned behavioral health services Decision Package
  Delays the implementation of redesigned behavioral health services until January 1, 2027.
•
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 2027 FY 2028
Positions 3.00 3.00
•
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.
•
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.
•
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.
•
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.


pdocagy2014 - Executive Budget Document Agency Details - 01-01-2026 15:49:45