WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) have asked Virginia health officials for a detailed assessment of the health care impacts of Medicaid cuts and per-capita Medicaid caps that are included in Republican proposals to repeal and replace the 2010 Affordable Care Act. The Republican Trumpcare proposal (AHCA - HR 1628) adopted by the U.S. House of Representatives on May 4^th included significant reductions in federal support for Medicaid services to the poor, disabled, pregnant women, the elderly and two-out-of-three Virginia nursing home residents. The Senate Republican proposal, negotiated in secret over several weeks, has not yet been publicly shared with states, Democratic colleagues, or the public.

According to the nonpartisan Congressional Budget Office, the AHCA would cut Medicaid by $834 billion over ten years. In fiscal year 2016, the federal government provided about $4 billion, or 51%, of the funding for Medicaid recipients in Virginia, according to the nonpartisan Kaiser Family Foundation. An analysis by The Urban Institute estimates the deep cuts and caps included in the House Republican Trumpcare proposal would require Virginia to spend an additional $900 million over ten years just to maintain the current level of Medicaid services. 

"A reduction of that magnitude or even one close to it – especially to an already efficient program like Virginia’s – could have devastating effects," Sens. Warner and Kaine wrote in a joint letter to Virginia Health Sec. William Hazel. "It is therefore essential that Virginians understand how a proposal of this nature would impact their access to care."

Medicaid is a joint federal and state healthcare partnership, and as former Virginia governors, both Sens. Warner and Kaine have successfully administered Virginia's Medicaid program. The senators asked Sec. Hazel a series of questions about Trumpcare's potential impacts on the health and well-being of vulnerable Virginians, including the potential loss of a requirement to include coverage for behavioral health services, as well as the impact on Virginians who are receiving addiction services through Medicaid managed care plans. The senators also asked Sec. Hazel if Trumpcare's cuts and caps will impact Virginia's legally binding agreement with the U.S. Justice Department to provide more costly community-based health services to vulnerable populations. 

The text of the letter is available here and below.   

June 20, 2017

William A. Hazel Jr.
Secretary of Health and Human Resources
P.O. Box 1475
Richmond, VA 23218

Dear Dr. Hazel:

We write to you regarding the impact Medicaid per capita caps, like those in the American Health Care Act (H.R. 1628), would have on Virginia families. Medicaid, a joint state-federal partnership, provides efficient, affordable, responsive, and high-quality health care to a diverse population, including children, pregnant women, individuals with disabilities, and people aged 65 and older. Medicaid also plays an essential role in driving health innovation and delivery system reforms that allow individuals to receive care in community-based settings. 

On May 24, 2017, the Congressional Budget Office (CBO) provided its estimate for H.R. 1628, and concluded that it would cut Medicaid by $834 billion over 10 years. A reduction of that magnitude or even one close to it– especially to an already efficient program like Virginia’s – could have devastating effects. It is therefore essential that Virginians understand how a proposal of this nature would impact their access to care. To that end, we request responses to the following questions:

1)    The AHCA could eliminate the requirement of the ten essential health benefits. How will this affect the public mental health safety net system as people lose behavioral health coverage through the marketplace?

2)     In Virginia, Medicaid managed care organizations provide mental health benefits for members in support of their special health care needs. How will a per capita-based cap on Medicaid payments:
a.     Impact those served in the public system, who suffer from chronic mental illness and substance use disorders?  
b.     Impact those with complex medical needs?

3)    Virginia is under a U.S. Department of Justice Settlement Agreement that requires Virginia to develop a robust and integrated system of care, by increasing community-based services and adding more waiver funded slots over the next four years.  The proposed per capita caps will significantly reduce Medicaid funding, which pays for these services.  How will this impact Virginia’s ability to remain compliant with the Settlement Agreement?

4) The creation of Medicaid waiver funded services (community supports) have enabled people with significant developmental disabilities to live with their families or near their families in community-based settings. What would be the impact of the reduction of funding on the community-based system? 

I recognize that it may not be possible to completely answer all these questions, and in such cases would appreciate any analysis you are able to provide. Thank you for your timely attention to this request. If you have any additional questions, please contact our offices.

Sincerely,

Mark R. Warner                                                                      Tim Kaine
United States Senator                                                             United States Senator