House of Delegates drives new Medicaid vehicle onto the legislative freeway

House Appropriations Committee Chairman Chris Jones, R-Suffolk, drove a new vehicle for Medicaid expansion onto the legislative freeway as the General Assembly entered the final week of its scheduled 60-day session.

Jones, the architect of a House budget that includes Medicaid expansion, commandeered a bill on Monday that was the model for the limited expansion of Medicaid services that the Senate included in its version of the budget without money to pay for it.

The committee stripped a financial contingency clause — linking enactment to funding in the budget — out of Senate Bill 915, proposed by Sen. Siobhan Dunnavant, R-Henrico, and whisked it to the House floor on an 18-0 vote, hours before the deadline for committees to complete work on all legislation.

 “This is to continue the dialogue in the arena of expanding health care coverage for Virginians,” said Jones, who is leading the six-member House contingent on a conference committee with the Senate that is trying to reconcile the competing budget proposals.

After the meeting, he said, “this keeps another vehicle for further discussion on this issue.”

The budget discussions began Sunday with a wide gulf between the chambers, primarily because of the House’s insistence on expanding Medicaid coverage for more than 300,000 uninsured Virginians and accepting billions of dollars in federal money to pay at least 90 percent of the bill.

The House budget also includes a “provider assessment” — essentially a tax on hospital revenues that the industry has conditionally supported — to pay the state’s share. The House version also includes an estimated $371 million in savings from using federal money to replace state tax dollars in paying for indigent care at hospitals, inmate medical costs, community mental health services and other Medicaid programs that currently receive less federal matching money.

The Senate budget would not expand Medicaid or impose a provider assessment, although two Republican-controlled committees approved an early version of Dunnavant’s bill that included a hospital tax to pay for limited expansion of Medicaid services for people with mental illness, addiction or complex medical conditions.

It also would extend Medicaid waiver services to a waiting list of about 2,300 Virginians with developmental or intellectual disabilities, create a new waiver program for people with brain injuries, and require screening of almost half a million children for childhood trauma.

Finally, it would require a statewide program of alternative transportation for people in psychiatric emergencies to be evaluated for additional involuntary detention.

The “Priority Needs Program” proposed by Dunnavant is part of the Senate budget, but only as what Senate Republicans call “aspirational goals” without any money to pay for them or apply for federal approval of waivers to carry them out. The Senate amended the legislation on the floor to eliminate the provider assessment before sending the bill to the House with a clause that links enactment to budget funding.

The Appropriations Committee did nothing with the bill until Monday, when Jones proposed to remove the contingency clause and send the measure to the House floor, where he expects a substitute amendment to be proposed that would expand Medicaid.

If the House were to amend the bill with Medicaid expansion and approve it, the Senate would have the option of accepting the amendment or not. Republicans control the Senate by a 21-19 majority, but Senate Finance Committee Co-Chairman Emmett Hanger, R-Augusta, remains an unpredictable vote on an issue that he has long championed.

Hanger voted against Medicaid expansion in the House budget and refused to support a provider assessment in either budget proposal. But he publicly voiced hope in a newsletter emailed to constituents over the weekend that the Senate will approve a more comprehensive approach to expanding coverage while bolstering the struggling federal marketplace and commercial insurance markets.

“With the House including some of the Medicaid expansion components in their budget, this certainly advances the conversation,” the senator wrote in “Emmett’s Virginian Voice.”

“The majority of the Senate has still not agreed to any such plan but I believe other conservative senators will emerge to stand with me,” Hanger wrote. “If not, I will stand with anyone willing to make bold moves to address the need because it impacts all of us, our budget, and my personal beliefs tell me it is the right thing to do.”

Gov. Ralph Northam said Friday that he is prepared to propose an amendment with Medicaid expansion if the assembly approves a budget without it. Lt. Gov. Justin Fairfax, a Democrat who supports Medicaid expansion, may not break a tie vote on the budget itself, but he could vote on either a gubernatorial amendment or the potential House substitute for Dunnavant’s bill.

Jones told the committee on Monday that sending Dunnavant’s bill to the House floor would allow “further discussion” on the issue until it is ready for a vote.

“I assume there would be a substitute that would be presented at that point in time for the body to consider,” he said.