On Thursday, the House of Delegates and Senate approved their respective budget bills setting the stage for them to head to a conference committee to negotiate the differences.  Both versions leave nursing facilities well positioned because they fully fund the Medicaid forecast, which included inflationary adjustments for nursing center services estimated at 2.9% and 3.0% in fiscal years 2019 and 2020, respectively. This funding is contingent upon passage of the final budget by the General Assembly and acceptance by Gov. Ralph Northam. 

In addition to the inflationary increase, both budget committees added $675,000 per year to the appropriation for special projects using the nursing center civil monetary penalty (CMP) fund. While it is unfortunate that the CMP fund has grown substantially, this added appropriation brings the total available for special projects to $1 million per year of the upcoming biennium. VHCA-VCAL intends to submit proposals for special projects to assist in improving the quality of care in nursing centers across the Commonwealth. 

We are grateful that the House and Senate have demonstrated their support for funding for nursing centers in their budgets. This action reflects legislators’ understanding of the important care you provide to your residents and the impact Medicaid rates have on your ability to provide that care. 

Medicaid Expansion

The expansion of Medicaid coverage to uninsured adults aged 18-64 remains a central focus of this budget. Currently, the House proposal creates a hybrid expansion of Medicaid utilizing a mix of private coverage and Medicaid with additional requirements, such as workforce participation/training. State funding of the House proposal relies upon a hospital provider assessment. Conversely, the Senate budget includes language for a more limited expansion for certain individuals with mental illness, substance use disorders, or life threatening or complex chronic care needs, but does not provide funding for these priorities.

Budget conferees will have to bridge significant differences between the House and Senate funding approaches to present their colleagues with a constitutionally-required state budget.