Human Services to continue expanding Medicaid coverage

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Human Services Commissioner Christopher Finch defended his $62 million General Fund budget in the Senate on Monday and updated senators on efforts to expand Medicaid in the territory.

"Whether or not to expand Medicaid is one of the hottest topics of debate in state budgets throughout the United States. Our approach is direct. We are working to expand Medicaid as fast and as much as we can," Finch said.

The Human Services Department administers the territory's Medicaid program, the Medical Assistance Program.

Medicaid is the nation's health care program for the poor. The states or territories share the cost of Medicaid with the federal government and create their own program plans, so Medicaid programs vary from jurisdiction to jurisdiction.

In April, the U.S. Centers for Medicare and Medicaid Services, CMS, deemed the territory had met the requirements under the Affordable Care Act to be considered a Medicaid Expansion State.

Therefore, the territory qualifies to receive a larger federal share for the Medical Assistance Program, although the amount still is not equivalent to what states get.

The federal matching rate for Medicaid expenses increases for two years from 55 percent to 57.2 percent, according to Finch. Once the territory adds childless adults as a covered group, the federal government will pay 78 percent of their costs, rising to 90 percent by 2019, he said.

"We have seen Medicaid grow from around 11,000 members to almost 14,000 members. The potential exists to expand to more than 25,000 members, thus greatly reducing the number of uninsured people and the burden on our hospitals and clinics," Finch said.

The department is working to build an integrated eligibility and enrollment system, which will be 90 percent federally funded if they can finish by December 2015, Finch said.

Any change to the territory's Medicaid program has to be approved by the federal government though a State Plan Amendment, or SPA. Since the department took over the Medicaid program from the V.I. Health Department in 2013, it has submitted about 15 amendments to expand eligibility, streamline processes and change payment methodology, according to Finch.

"Our SPA to add breast and cervical cancer coverage for the uninsured has just been approved, and we expect our SPA to add podiatry and optometry coverage to be approved very soon," Finch told the Senate Finance Committee on Monday.

"We are readying a SPA to allow presumptive eligibility for the hospitals, which enables them in an emergency to enroll seemingly qualified patients for temporary Medicaid coverage."

Human Services plans to continue Medicaid expansion in four phases, Finch said, and the first phase, to raise income eligibility limits for children and pregnant women, was implemented in August.

Finch said he had hoped the second phase - to reach out to people who would qualify but currently are not receiving Medicaid benefits - would have been done by now, but CMS rejected parts of the department's quick enrollment plan. Human Services now is waiting for CMS to approve its revised outreach and enrollment methodology, he said.

The third expansion is to increase income limits for all groups, and the fourth is to add childless adults as a covered group, Finch said.

FY 2015 budget request

The Human Services Department has a complex budget made up of many federal and local sources, Finch said.

The FY 2015 General Fund operating budget amount of $62.3 million funds the department's 10 divisions and many programs.

The governor has recommended the department also get about $5.5 million in the miscellaneous section of the executive budget, which includes: $3 million for Medicaid matching funds; $1.5 million for the energy crisis assistance program; $432,000 for the quality rating system for early childhood education; $475,200 for four nursing home beds at Sea View; and $86,400 for the cancer care program.

The department also gets about $3 million from three local funds: the Home for the Aged Revolving Fund; the Crisis Intervention Fund (which is re-granted to local nonprofits); and the Lottery's Pharmaceutical Assistance Fund.

About $2.1 million is earmarked for the department in the miscellaneous section of the budget, but the money is passed through Human Services and on to local nonprofits and service providers.

The department expects to receive about $68.6 million in federal funds in FY 2015, as well as $55 million in Supplemental Nutrition Assistance Program (formerly known as food stamps) funding, Finch said.

Overall, the department is expecting to receive about $196.6 million for FY 2015 operations, according to Finch.

- Contact Aldeth Lewin at 714-9111 or email

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