Let the countdown begin. Once Gov. Ralph Northam puts pen to paper signing the bill that makes Medicaid expansion a reality, health care professionals and benefits administrators will have just about six months to get ready for what is expected to be a significant influx of patients. Providers in the Lynchburg area anticipate — and already are preparing for — thousands more patients who will be eligible for Medicaid benefits.
“People can take a big breath and know that Virginia is going to do something to help people with low incomes,” Virginia Huntington, assistant director with the Lynchburg Department of Social Services, said Friday as she talked about what happens next for localities like Lynchburg.
Huntington said because Virginia has not written the policy yet, there are countless unknowns but enough working theories to begin preparing.
Now Virginians who make up to 138 percent of the federal poverty level — which in 2018 is $16,753 annually for an individual and $34,638 for a family of four — could be eligible for Medicaid benefits.
Huntington said she has been told as many as 4,200 additional Lynchburg residents now could be eligible for Medicaid.
“That’s many new caseloads, and we expect to see the most dramatic increase initially in our intake units” that process Medicaid applications, Huntington said, adding the state has assured localities it will provide money for additional staffing to meet demands.
Nearly 12,000 additional residents in the counties of Amherst, Appomattox, Bedford, Campbell and Nelson and the city of Lynchburg will become eligible to apply for Medicaid, according to estimates from the Commonwealth Institute for Fiscal Analysis, a Richmond-based firm that provides nonpartisan analyses of fiscal and economic policies.
In Bedford County on Friday, construction workers were building an addition to double the size of the Johnson Health Center’s Bedford clinic, the nonprofit’s fastest-growing practice during the past 18 months — even before Medicaid expansion.
“We’ve been talking about this for probably about a year and a half, and we anticipated the movement on Medicaid, and we believed it would likely happen this year and pass,” said Gary Campbell, CEO of the Johnson Health Center, a Federally Qualified Health Center that serves Lynchburg and the counties of Amherst, Bedford and Campbell.
The expansion adds nine exam rooms to a clinic that provides OBGYN, pediatric, behavioral health and adult care services. By this summer, it will be able to accommodate 4,000 to 5,000 new patients.
Campbell said because JHC enrolled more than 1,800 new patients from 2016 to 2017 and already is on pace to add another 2,000 this year, it is familiar with rapid growth.
“We believe there are as many as 4,300 in our service area that are not being served by a health center” and now will be eligible for Medicaid, Campbell said Friday.
Campbell said the JHC clinics are staffed for the influx, and trained certified counselors are ready to assist patients with Medicaid and federal health care marketplace questions.
The influx will be a welcome challenge.
The Community Health Center at 800 Fifth St. in Lynchburg serves patients without regard to insurance or health need while the Free Clinic of Central Virginia, a nonprofit on Lynchburg’s Main Street, serves the underinsured, uninsured and individuals with an income up to 200 percent of the federal poverty level, which this year is $24,280 annually for an individual and $50,200 annually for a family of four.
Christina Delzingaro runs both. She expects between 3,000 and 6,000 new Medicaid patients will seek health care as a result of the expansion.
And that, she said, will buoy the entire health care system.
At her two clinics, for example, 51 percent of patients are uninsured, meaning the centers provide care but receive no payments other than donations from patients. She estimates 95 percent of those patients could be eligible for Medicaid now.
Once these patients are covered by Medicaid the clinics will be reimbursed about 71 cents on the dollar for the care they provide.
Her hope is that these patients will in turn begin coming in for preventive care, rather than waiting for costly health care emergencies, thus improving their overall health.
At the same time the clinics go from getting no money for a service to getting paid, and that means revenue for nurses, patient education, better pay for staff and more, Delzingaro said.
For hospitals, the reimbursement rate is far better.
Centra and other hospitals will see Medicaid reimbursement rates significantly increase to parallel the reimbursement rates granted by Medicare.
Historically Medicaid has reimbursed providers for about 71 percent of health care costs. As of Oct. 1, Medicaid will reimburse hospital in-patient and out-patient care for 89 percent of costs, which is the same reimbursement rate for Medicare.
Private providers, Centra Medical Group physician practices and those at the Free Clinic, Johnson Health Center, and Community Health Center will not see the same increase in reimbursement rates. Centra CEO and President E.W. Tibbs said that is because hospitals — except for those that are state funded — are helping fund the Medicaid expansion through two assessments, or taxes, on revenue, according to legislation passed last week by the General Assembly.
For Centra, one provider assessment alone is expected to cost the system about $20 million annually. For this first year it is expected to cost about $10 million.
In return for hospitals’ investments, the taxes Virginians already pay — which for years have funded other states’ initiatives like Medicaid expansion — will be rerouted back to Virginia.
“Centra’s deeply appreciative …. It helps us to be more financially sustainable short term and long term” and to further the mission of providing health care to all, Tibbs said Thursday.
“Without question,” Tibbs said, the Medicaid expansion allows Centra to increase patient access to preventive and primary care.
But no one is calling the expansion perfect.
“I will say this is progress,” Tibbs said. “We hope to build on this.”
Delzingaro and Campbell agree. Although thrilled with the expansion, Delzingaro said this does not eliminate the need for free clinics and their volunteers.
In the future, they said, legislators need to increase Medicaid reimbursements to all providers and add benefits such as dental, vision and podiatry to Medicaid, which are critical to patients like diabetics.
“I don’t want to discount this at all,” Delzingaro said. “I’m very excited about the birthday cake. I’m not going to complain that they spelled my name wrong in the icing.”
According to the budget adopted May 30, Medicaid expansion is expected to go into effect on Jan. 1, 2019.
Reach Amy Trent at (434) 385-5543.