Enrollment begins Nov. 1 for Medicaid expansion

Jeremy M. Lazarus | 10/25/2018, 6 a.m.
Shanté Williams is among tens of thousands of Virginians patiently waiting for Thursday, Nov. 1, to arrive. That’s the start ...

Shanté Williams is among tens of thousands of Virginians patiently waiting for Thursday, Nov. 1, to arrive. That’s the start date for enrollment in the state’s expanded Medicaid program.

The Richmond convenience store clerk is vowing to be among the first in line to sign up for health insurance under Virginia’s expanded Medicaid program when enrollment begins for a projected 423,000 Virginia adults who cannot afford coverage and did not previously qualify for taxpayer-supported coverage.

“Do you know what this means? I won’t have go to an emergency room when I get sick. I can see a doctor,” the 36-year-old single mother of two said with bubbling enthusiasm.

“My children have coverage under a state program, but I don’t qualify,” she said. “I make too much. I had hoped Obamacare would help, but I can’t afford insurance even with the subsidy. What the state is doing for people like me is a godsend.”

Information on the expansion, eligibility and enrolling can be found at www.coverva.org or by calling toll-free (855) 242-8282. For the deaf or hearing impaired, call (888) 221-1590.

The Richmond Department of Social Services and other social services offices also are to provide assistance to those who need help signing up.

Gov. Ralph S. Northam, who pushed the expansion through a once fiercely opposed General Assembly last May, hopes that every adult who qualifies will take advantage of the enrollment period that will run through Saturday, Dec. 15.

The new coverage will begin Jan. 1, with people who sign up receiving insurance cards in the mail. The coverage will link participating adults to community doctors, hospitals and emergency services, as well as to preventive and wellness services, but will not extend to routine dental, vision or hearing services.

Meanwhile, the state is poised to receive at least $1.7 billion a year in new federal money to help underwrite the cost.

The expanded health coverage is aimed at men and women ages 19 to 64 who are too young for Medicare and who meet income requirements based on family size. Even those with pre-existing conditions will be eligible, according to information at coverva.org.

Those who enroll will have six plans to choose from once they pass the income eligibility test, coverva.org states. The managed care options are to be provided through Aetna, Anthem, Magellan, Optima Health, United Healthcare and Virginia Premier.

For some, getting past the first hurdle will be easy. For example, Ms. Williams, with a three-member household that includes her two children, will be eligible if her gross income is $28,677 or less before taxes and deductions, or the equivalent of $13.78 an hour for a 40-hour a week job.

“I qualify, believe me,” said Ms. Williams, who said she is paid about $10 an hour as a store clerk.

Until this expansion, an adult in a three-person household with at least one child was limited to making $6,900 a year in gross income to qualify for Medicaid, state officials said.

The expansion also ensures coverage for childless adults who live alone and are not disabled. They were ineligible until now under Virginia’s Medicaid guidelines.

Such adults now will qualify if their gross income before taxes and deductions is $16,754 or less, the equivalent of an $8 an hour, 40-hour-a-week job or just above the $7.25 an hour minimum wage. Disabled individuals living alone who made less than $9,800 a year previously qualified; now they can make up to $16,754 a year.

In a two-person household, adults with a gross annual income at or below $22,715 are eligible, while adults in a family of four can qualify if their gross income is $34,638 a year or less.

The income limits are expected to rise each year as the government adjusts the poverty line for inflation.

The new health insurance will not be completely free, according to the legislation that passed and the governor signed into law. Republicans insisted on imposing a premium ranging from $1 a month to 2 percent of income, and there could be co-pays for some services. Specifics are not yet available on the website.

Republicans also insisted on imposing a work requirement, though the Northam administration has said the requirement is still awaiting federal approval and could take up to two years to fully implement.

As written, participants in the Medicaid expansion must work, attend school, take part in a job-training program or participate in some kind of “community engagement” that has yet to be defined.

However, there are numerous exemptions, such as for women who are pregnant or have just given birth, a parent caring for a dependent child, a person who is suffering from a serious illness or disability or a person who has been diagnosed with a serious mental illness.

Despite that, the health care expansion should ultimately boost health outcomes for “thousands of Virginia adults,” stated Dr. Daniel Carey, state secretary of health and human resources.

Among other things, people like Ms. Williams who enroll will gain “a comprehensive package of health services, including coverage for visits to primary and specialty care doctors, hospital stays and prescription medications,” Dr. Carey stated.

“Individuals with chronic diseases will have access to the sustained care that is essential to maintain their health,” he continued.

He also noted that the new coverage means “Virginians requiring behavioral health and addiction treatment will be connected to a robust array of services.

“This new coverage will help individuals across the commonwealth who are our friends, our neighbors, our caregivers and the people we meet daily in coffee shops and restaurants,” added Dr. Jennifer Lee, director of the Virginia Department of Medical Assistance Services that will manage the program

“This is not only historic for the commonwealth, but also greatly significant for the thousands of human services professionals statewide who are dedicated daily to helping Virginians achieve well-being,” stated Duke Storen, commissioner of the Virginia Department of Social Services.

“Those of us who share a mission of providing vital services to Virginians understand first-hand how access to health coverage reaches far beyond the individual.

“Families and communities that both support and surround our most vulnerable citizens will reap the rewards of a healthier adult population,” he noted.