Virginia says insurers can handle Medicaid expansion, but doctor shortages remain

Nov. 27--Virginia's Medicaid agency says insurance companies can handle the additional patients coming with Medicaid expansion, even though parts of the state suffer from a shortage of primary care doctors.

An outside quality review firm found Virginia's managed care companies meet federal and state standards for the networks needed to serve the more than 300,000 Virginians signing up for coverage through Medicaid expansion, according to a written presentation by the director of the state Department of Medical Assistance Services.

But Jennifer Lee added in her presentation to a legislative panel Monday that only an estimated 63 percent of primary care doctors in Virginia participate in Medicaid.

That's down from about 75 percent at the start of the decade.

Over that time, the rates Virginia Medicaid pays doctors have fallen further behind what the federal Medicare system -- considered one of the toughest negotiators of fee discounts -- pays. In 2011, Medicaid fees for adult primary care services stood at 73 percent of Medicare rates, while this year they amounted to just 66 percent.

That widening gap, and the limited number of primary care doctors in many parts of the state, could make it hard for some Medicaid beneficiaries to get care, Lee said.

But managed care companies have a variety of ways to pay doctors and contract for their services, as opposed to the fee-for-service rates that have been lagging Medicare, she added.

The managed care companies that cover Medicaid beneficiaries in Virginia all have formal plans to expand their networks and hold on to doctors already in their networks, Lee said.

State Medicaid officials now expect some 360,000 more Virginians will sign up for coverage, up from an earlier forecast of 300,000.

A spokeswoman for Lee's agency, Christina Nuckols, said more people than expected got the word about Medicaid expansion thanks to outreach through the state Department of Social Services and the federal Affordable Care Act marketplace.

The federal government will cover 90 percent of the cost of Medicaid expansion, with a new tax on hospitals covering the rest. Costs for care of the low-income children and adults with disabilities who were already on Medicaid is split 50-50 with the federal government. Currently, Medicaid costs Virginia about $5.2 billion a year.

The Medicaid expansion compromise approved by the General Assembly this year includes a work requirement and cost-sharing by some beneficiaries, the terms of which must be approved by the federal Centers for Medicare and Medicaid Services.

The state submitted its formal request for that approval last week, with some final tweaks that include saying self-employed individuals can satisfy the work requirement and clarifying how coverage can be reinstated if beneficiaries don't meet the work requirement or don't pay their share of coverage costs. There's no deadline for the federal government to act, but in the meantime, those eligible for Medicaid under the expansion will be covered.

Dave Ress, 757-247-4535, [email protected]

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