The General Assembly’s decision to expand Medicaid eligibility greatly increased the amount of money the state will get for the program—but will end up costing the Loudoun County government, which needs to hire nine new positions to cover the increased workload.
The Virginia Department of Social Services and the Department of Medical Assistance Services’ have estimated that Loudoun County will see about 5,800 new Medicaid participants, about 25 percent of Loudoun’s uninsured population. According to county staff members, that will mean a 22 percent increase in the total number of Medicaid cases managed by the county Department of Family Services.
“It’s going to be a significant lift for us,” said Family Services Director Glenda Blake.
To handle that caseload, Blake said her department will need nine new hands on deck. Those would include benefit workers, a benefit supervisor, a benefits trainer, eligibility screeners, and administrative support. That would maintain the department’s average caseload of 725 cases per worker.
In the first year of the program, the state will cover the full cost of the expansion, sending the county $712,173. In the future, however, the county will be required to fund 15.5 percent of those positions, a standard local match for positions administering state programs. That comes to $110,386.82 in new county funding—although County Administrator Tim Hemstreet cautioned any calculation would be an estimate, as county employees typically receive annual raises, and the county is also in the middle of reviewing its pay structures. County staff members have estimated the county will need about $125,000 for its local match in its next budget.
And Blake said there are other costs to those new hires.
“It’s not like you can hire people and they can get to work the next day,” Blake said. “The state has a required amount of training for every person who has a benefits job.”
Those people have to leave the county for their training, taking them out of the office on a workday to receive their face-to-face state-mandated training. Blake said she has asked the state for a “a technological solution” so that her employees are not taken out of the office for a full day.
The new positions will go into the department’s Benefits Unit, which is already funded for 38.5 full-time equivalent positions and handles Medicaid, Temporary Assistance for Needy Families, the Supplemental Nutritional Assistance Program, and the Energy Assistance Program. Under the new state legislation, that unit will also be responsible for the new Training, Education, Employment, and Opportunity Program, which requires every able-bodied, working age adult to work or be enrolled in training or education for a certain number of hours a month.
The Medicaid expansion was adopted after months of deadlock on the state budget. In May the General Assembly passed a compromise bill based on negotiations between two Republican committee chairmen, Sen. Emmet W. Hanger Jr. (R-24), co-chair of the Senate Finance Committee; and Del. S. Chris Jones (R-76), chairman of the House Appropriations Committee. It implements the Affordable Care Act in Virginia by covering all adults up to 138 percent of the federal poverty level, estimated at 300,000 people. Those above the federal poverty level—this year set at an annual income of $25,100 for a family of four—would pay premiums on a sliding scale. In so doing, it also opens Virginia up to greatly expanded federal funding—rather than a 50/50 split on Medicaid funding, the federal government will fund 90 percent of Medicaid costs. In the first year of the expansion, the federal government pays for all Medicaid spending.
The Medicaid expansion is a hallmark of the 2010 Affordable Care Act. Virginia was the 33rd state to accept the expansion.
This year’s state budget bill won support from every Loudoun state representative except Del. Dave A. LaRock (R-33) and Sen. Richard H. Black (R-13). The county saw a Democratic surge in its recent elections, leaving LaRock, Black and Sen. Jill Holtzman Vogel (R-27) as the last state Republicans with district territory in Loudoun. Vogel was later censured by the Loudoun County Republican Committee for her vote in favor of Medicaid expansion.
On Oct. 9 the Board of Supervisors’ finance committee voted unanimously to recommend the full board authorize those nine new positions.