Medicaid at a Glance

The Virginia Medicaid Program at a Glance

The Virginia Medicaid program is authorized under Title XIX of the Social Security Act and administered by the Virginia Department of Medical Assistance Services (DMAS).

Federal financial assistance is provided to states for coverage of medical services for specific groups of low-income people. Federal matching payment rates are based on the state’s per capita income. The federal match rate for Virginia is approximately 60% for 2011.

Who Is Covered?

While Medicaid was created to assist people with low-income, coverage is dependent upon other criteria as well. Eligibility is primarily for individuals falling into particular categories, such as low-income children, pregnant women, the elderly, persons with disabilities, and parents meeting specific income thresholds. In Virginia, income and resource requirements vary by category.

An individual’s need for medical care, the state of his health, or his coverage by private health insurance, have no effect on his Medicaid eligibility. The eligibility determination consists of an evaluation of an individual’s situation by comparing each of the individual’s circumstances to an established standard or definition. The evaluation provides a structured decision-making process. An individual must be evaluated for eligibility in all covered groups for which he meets the definition, and the applicant/enrollee shall be informed of all known factors that affect eligibility.

The nonfinancial eligibility requirements are:

a. Legal presence in the U.S., effective January 1, 2006

b. Citizenship/alien status

c. Virginia residency

d. Social Security number (SSN) provision/application requirements

e. Assignment of rights to medical benefits and pursuit of support from the

absent parent requirements

f. Application for other benefits

g. Institutional status requirements

h. Covered group requirements

The financial eligibility requirements are:

a. Asset transfer for individuals who need long-term care

b. Resources within resource limit appropriate to the individual’s covered

group.

c. Income within income limit appropriate to the individual’s covered

group.

MEDICALLY NEEDY INCOME LIMITS
EFFECTIVE JULY 1, 2009
Group I Group II Group III
Family Semi- Semi- Semi-
Size Annual Monthly Annual Monthly Annual Monthly
1 $1,592.39 $265.39 $1,837.38 $306.23 $2,389.59 $398.26
2 2,027.57 337.92 2,262.85 377.14 2,880.04 480.00
3 2,388.59 398.09 2,633.58 438.93 3,246.05 541.00
4 2,694.83 449.13 2,939.81 489.96 3,552.27 592.04
5 3,001.06 500.17 3,246.05 541.00 3,858.51 643.08
6 3,307.29 551.21 3,552.27 592.04 4,164.74 694.12
7 3,613.52 602.25 3,858.51 643.08 4,470.97 745.16
8 3,981.00 663.50 4,225.98 704.33 4,777.21 796.20
Each addl 411.56 68.59 411.56 68.59 411.56 68.59
person

What Services Are Covered?

The Virginia Medicaid Program covers all of the federally mandated services mandated services as well as several optional services.

How is Care Delivered?

Virginia Medicaid is delivered through two delivery models: a managed care model where care is coordinated by contracted managed care organizations (MCOs) and a fee-for-service (FFS) model, where service providers are reimbursed directly by the DMAS.

Expenditures and Enrollees

The number of people enrolled in the Virginia Medicaid Program has increased by 49% over the last ten years. Despite enrollment growth, Virginia’s eligibility criteria are among the strictest in the nation.

Group 2000 2010 % Change
Aged, Blind, and Disabled 224,313 276,968 23%
Children 352, 926 563,379 60%
Adults 96,888 164,814 70%
Total 674,127 1,005,161 49%

Virginia ranked near the lowest levels nationally regarding Medicaid spending per capita (48th in 2007).

Questions? Comments?  Don’t hesitate to email me at DelDAlbo@house.virginia.gov.

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