House Republicans and Gov. Terry McAuliffe finally have a common plan they can talk about for expanding health care.
The House Republicans unveiled a budget proposal Thursday that would increase spending by $124.2 million for a series of initiatives to expand behavioral health care for people with serious mental illness, bolster the health care safety net, and expand benefits to pregnant women and the children of low-income state employees.
The plan, outlined by Del. John M. O’Bannon III, R-Henrico, in a speech on the House floor, sought to counter the program McAuliffe launched last month without legislative approval to expand behavioral health and medical care to as many as 20,000 Virginians with serious mental illnesses, such as schizophrenia or bipolar disorder.
“It’s a much more comprehensive approach to care that will meet the needs of this vulnerable population,” O’Bannon said in his speech.
But McAuliffe emerged from a meeting on Thursday afternoon with House budget leaders with optimism about the prospects for the Healthy Virginia plan he announced in September after House Republicans thwarted him in his quest to expand the state Medicaid program under the Affordable Care Act.
“While some differences remain, he is glad they chose to accept so much of what he proposed in September,” said Brian Coy, the governor’s communications director.
The centerpiece of the Healthy Virginia package is the Governor’s Access Plan, which began enrolling people with serious mental illness last month after the Centers for Medicare & Medicaid Services approved a Medicaid waiver to allow the program.
House Republicans challenged the governor’s authority to enroll people in a new program without legislative permission, but they acknowledged the need to provide behavioral and medical care to people with serious mental illnesses.
“I think we all agree this is a vulnerable population we want to help,” O’Bannon said after his speech. “We have a little different direction.”
The House plan also would fund two other pieces of the Healthy Virginia plan that McAuliffe announced in September. It would provide dental care for pregnant women in the Medicaid and FAMIS programs, as well as allow low-income state employees to secure affordable health care for their children under FAMIS, or Family Access to Medical Insurance Security.
But the House plan for people with serious mental illness is the big-ticket item in the budget package the House Appropriations Committee will unveil Sunday. It would provide behavioral health services and prescription drug coverage to more than 29,000 people with serious mental illness and increase the governor’s spending plan by more than $5 million.
House Appropriations Chairman S. Chris Jones, R-Suffolk, informed McAuliffe of the proposal in a telephone conversation Wednesday evening and met with the governor and Secretary of Health and Human Resources Bill Hazel on Thursday afternoon to share the details.
Jones also delivered a four-page letter to Hazel on Thursday morning that challenged the governor’s authority to begin the program without legislative approval and pay for it with money that the assembly had not appropriated.
“I am concerned that this plan is based on questionable regulatory authority, directly violates a plain reading of budgetary constraints and was executed in such a way that it undermines the separation of powers and unnecessarily erodes trust between the legislature and the executive branch,” he wrote.
“For the governor to unilaterally create a new program in Medicaid and use general funds to pay for it is not acceptable,” Jones concluded.
Coy said the governor would review the details of the House plan to ensure it would comply with the Medicaid waiver approved for Virginia by the Centers for Medicare & Medicaid Services.
“The governor is happy to see House Republicans recognize the need to expand care for thousands of Virginians with serious mental illness, even if it took the announcement of his own plan to motivate them to act,” Coy said. “He will continue to work with the General Assembly to tailor the best possible outcome.”
“However, this plan is no substitute for Medicaid expansion, which would cover these Virginians and hundreds of thousands more at significantly less cost to Virginia taxpayers,” he added.
The House plan would cover people who earn up to 80 percent of the federal poverty level, or $9,330 a year, while the governor wants to cover people earning up to 100 percent of the poverty level, $11,670 a year. Both would rely on federal Medicaid dollars to cover half of the cost, although O’Bannon told the House, “Let’s be clear: We are not expanding Medicaid.”
It’s not clear what would happen to people with serious mental illness already enrolled in the governor’s program who earn between 80 and 100 percent of the federal poverty level if the House approach prevails.
“You’d have to ask the administration that, because they’re the ones who pulled the trigger,” O’Bannon said.
The House plan would rely on free clinics and community health centers to provide medical care to the new population, including an additional $6 million in the budget to expand their treatment capacity. McAuliffe’s program provides limited outpatient medical benefits to participants.
O’Bannon and other House budget leaders said their proposal would build on the $54 million increase in state spending on behavioral health services last year in response to an attack on Sen. R. Creigh Deeds, D-Bath, by his mentally ill son, who then killed himself.
The money went primarily to expanding emergency services, such as secure drop-off centers for assessing people in psychiatric crisis and community treatment teams that try to keep people with mental illness out of crisis. The proposed plan would add four more drop-off centers and two more treatment teams.
“We’re redirecting what we think is a better use of the money,” O’Bannon said.
By MICHAEL MARTZ Richmond Times-Dispatch