The General Assembly approved a slower version of Medicaid expansion than we would have liked, but the state is now one step closer to Medicaid expansion. After much compromise and hard work, the General Assembly decided that Medicaid expansion would happen, but not before July 1, 2014. They want to make sure that “meaningful” reforms to Medicaid are in place and they have appointed a committee of five state delegates and five state senators to decide when the reforms have been implemented. Medicaid expansion will begin after three Delegates and three Senators on the committee votes that enough progress has been made on reforms for expansion to begin.  

We had hoped that expansion might begin on January 1, 2014. While the delay means the savings from covering the uninsured are delayed (and the state misses out on about $500 million, maybe more) and the job creation starts later, all of the benefits of expansion will come to Virginia next year.  

The committee to decide when the reforms have been implemented may be important. The House of Delegates has appointed Delegates Steve Landes (Augusta), Jimmie Massie (Henrico), Beverly Sherwood (Frederick), John O'Bannon (Henrico) and Johnny Joannou (Portsmouth) to this committee. The state Senate has not yet made appointments.  

On the Health Benefits Exchange (the new marketplace where small business will be able to get larger group rates), the General Assembly again did some interesting legislating. While the state could not set up a Virginia-run Exchange, both bodies of the Virginia General Assembly passed legislation setting up a “partnership” exchange, where the federal government runs the website and the state does the insurance regulation. But at the end of the session, both chambers passed amendments saying that (even though the state legislation is what the federal law calls a “partnership”) the legislation did NOT set up a “partnership” Exchange. So while it is not perfect, the Exchange will be set up with some state participation. The Exchange will begin operating late this year.    

Now that the General Assembly has finished with legislation, we will be working with Virginia state officials and the federal government on implementation of the new Health Benefits Exchange and Medicaid expansion as well as outreach to small business to inform them of these opportunities.  

There is a federal income tax credit for small businesses that provide health insurance for their employees. The credit will carry over into the future if it is not all used in one year. IRS form 8941 contains information: http://www.irs.gov/pub/irs-pdf/i8941.pdf

As part of the overall health care reform effort, Virginia has loosened up the limits on the work that Physicians Assistants and Dental Hygienists are allowed to do. Under several new laws, these professionals are allowed to do the work they are trained to do without a doctor looking over their shoulder.  

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