Charlottesville health care nonprofits brace for impact of One Big Beautiful Bill

Patients, doctors and nurses across the country are waiting with bated breath as the fate of the Trump-endorsed One Big Beautiful Bill, which proposes a $625 billion cut to Medicaid, is decided on the floor of the U.S. Senate in the coming month.

Although the GOP budget reconciliation bill has yet to pass into law, nonprofit organizations that rely on the government-sponsored health insurance for low-income Americans in the Charlottesville area are already bracing for impact.

Since 1969, the Region Ten Community Services Board has been a hub for various resources for those with mental health disorders, developmental disabilities, substance addictions and behavioral issues.

More than 30% of its operating budget comes from federal funds or billing Medicaid. Region Ten typically bills Medicaid around $18.4 million annually for the roughly 3,000 people it serves in Central Virginia who are eligible for coverage. An additional 800 individuals in the region are eligible for Medicaid under an expansion measure passed by the Virginia General Assembly seven years ago to cover all Virginia adults under 65 who earn up to 138% of the federal poverty level.

"Should Medicaid expansion end in Virginia, the need for services through Region Ten will increase, while the capacity to provide services will decrease," according to a Region Ten statement sent to The Daily Progress by spokeswoman Joanna Jennings. "If Medicaid expansion ends, those served under Medicaid expansion will no longer have insurance coverage for behavioral health services.

Today, there are 1.5 million children and adults on Medicaid in the commonwealth, including roughly 630,000 that were covered as a result of the expansion. Region Ten estimates it will lose around $3.2 million in annual revenue from Medicaid if the 2018 expansion is reversed. So far, no funding has been lost — yet.

Region Ten will maintain other revenue sources, including funding from state and local governments, donations, self-payment and grants, but even some of those are under threat. Jennings said that the organization has seen several grants through the U.S. Department of Health & Human Services, led by vaccine skeptic and conspiracy theorist Robert F. Kennedy, "end earlier than expected."

The unexpected termination of those federal grants has affected "a small number of positions" within Region Ten, whose salaries or positions were entwined with the grants.

"We are currently working with those impacted staff to explore other employment opportunities within the agency," according to Jennings.

The passage of the One Big Beautiful Bill would have a cascade effect felt across the health care industry if thousands of patients lose access to "public behavioral health safety," according to Region Ten.

"People who do not have access to needed ongoing behavioral health services are more likely to experience a psychiatric emergency," wrote Jennings.

An increase in such emergencies will lead to an increase in visits to emergency departments which will likely directly correlate with a rise in the number of people admitted to local jails and state psychiatric hospitals, "who have historically been the default service providers when there are not alternative community based services," according to Jennings.

Region Ten is far from the only nonprofit group in the Charlottesville area that relies on Medicaid funding.

Back in mid-April, Sarah Tok, spokeswoman for the VIA Centers for Neurodevelopment, told The Daily Progress that the nonprofit provider of educational programs for those on the autism spectrum does bill Medicaid for "our adult and pediatric services and would be forced to react accordingly if Medicaid refuses payment for any reason."

At the time, though, the organization was "not aware of any federal plans to cut Medicaid funding for these purposes."

While there's little to be done locally about the progression of the One Big Beautiful Bill, Region Ten is attempting to manage what remains within its sphere of influence. That includes the development of a conservative budget for the upcoming fiscal year that will hopefully "put ourselves in as strong a position as possible."

Region Ten also said its leadership is calling on state officials to retain the commonwealth's Medicaid expansion regardless of federal cuts.

Some of those legislators are listening.

Former U.S. Rep. Abigail Spanberger, the Democratic nominee for governor this year, decried the GOP budget bill in a statement released on the day it was passed by the House of Representatives.

"If signed into law, this legislation would threaten the survival of Virginia's rural hospitals, disrupt the ability of small businesses to provide coverage to their employees, and risk driving up healthcare premiums for working families," she said.

Del. Katrina Callsen, D-Albemarle, threw her weight behind Spanberger during a recent press conference at her district office in downtown Charlottesville.

Joined by David Toscano, a former Charlottesville mayor and Democratic minority leader in the House of Delegates, and sitting Charlottesville Mayor Juandiego Wade, the three Democrats spoke of the critical importance of Medicaid for Virginians and the detrimental impacts of the One Big Beautiful Bill.

Republicans in Congress have continued to push a message that the budget bill is designed to cut "waste, fraud and abuse" from the Medicaid program. House Speaker Mike Johnson, a Louisiana Republican, has repeatedly claimed that the only Medicaid recipients who will lose insurance are the 1 million-plus illegal immigrants who are "cheating the system."

However, the nonpartisan Congressional Budget Office has estimated the One Big Beautiful Bill would cost nearly 14 million Americans their health care coverage over the next decade if it passes the Senate.