Tag: medicaid expansion

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Tooth be told

The Free Clinic offered dental care to uninsured patients in the parking lot during the pandemic. Photo: Zack Wajsgras.

Smile! On July 1, over 750,000 adult Virginians became eligible for dental coverage under the state’s expanded Medicaid dental plan. Previously, only children and pregnant Medicaid recipients were eligible for coverage.

“Oral health is an integral part of overall health, well-being, and quality of life,” said Governor Ralph Northam in a press release. “This historic expansion of services will ensure that adult Medicaid members across our Commonwealth have access to the quality dental care they deserve. I am proud of the bipartisan support and strong collaboration we have received from dentists and health care advocates that helped us reach this significant milestone.”

The expansion doesn’t solve Virginia’s dental problem overnight, however. “The recent expansion for adult dental is great, and it’s a step in the right direction,” says Susan Sherman, executive director of the Charlottesville Free Clinic, which provides health care to uninsured and underinsured area residents. “But the reality is that there aren’t a lot of dentists that are accepting Medicaid.”

Under the new plan, those 21 and over who are receiving full Medicaid and other state health benefits will also receive coverage for X-rays and examinations, cleanings, fillings, root canals, gum-related treatment, dentures, tooth extractions and other oral surgeries, and other appropriate general services such as anesthesia. Orthodontic care is not included in the plan.

The funding for dental coverage was passed by the state legislature as part of Virginia’s massive annual budget bill, which was signed into law by Northam in the spring. The dental plan builds on Virginia’s 2019 Medicaid expansion. In 2018, after Republicans nearly lost control of the House of Delegates, a handful of Republican state senators dropped their years-long opposition to Medicaid expansion, approving a bill that allowed hundreds of thousands access to health care. 

“When we expanded Medicaid eligibility in 2019, our new members identified dental services as a top need,” said Department of Medical Assistance Services Director Karen Kimsey in a statement. “With more than 562,000 new members as a result of Medicaid expansion, we appreciate the support of Virginia dentists in helping us meet the tremendous need we know exists in our Commonwealth for oral health care.”

The Medicaid expansion doesn’t mean everyone in Virginia can immediately get the treatment they need. Sherman says that Medicaid reimbursement is pretty low, so there is not a huge incentive for private practice dentists to treat patients on Medicaid, and many don’t.

Additionally, some areas in Virginia, including Nelson and Buckingham counties, don’t have enough dentists, period. According to the Kaiser Family Foundation, Virginia has 97 dental health professional shortage areas—communities where there aren’t enough practicing dentists to support the population. Coverage expansion doesn’t matter if there aren’t any dentists around.

Because so few dentists accept Medicaid, says Sherman, the medical professionals at the Free Clinic in Charlottesville will still have their hands full treating patients.  “There are a lot of people that aren’t going to be able to receive dental care anywhere else,” she says.

Sherman also warns of the “Medicaid churn.” Many people who go on Medicaid don’t stay on Medicaid because their employment status and income change often. Finding a steady provider can be difficult for people bouncing on and off Medicaid. 

“Medicaid expansion is important, and it absolutely sends the right signal,” she says. “It puts money in policy where it needs to go, but the implementation is a challenge.”

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‘Big deal’: Nearly 5,000 locals eligible for coverage with Medicaid expansion

House Minority Leader David Toscano says not only will 400,000 Virginians get coverage with Medicaid expansion, but teachers will get raises and other budget items will be funded with the influx of federal dollars. Ellie Williams

Mary Linn Bergstrom was in Boston over Memorial Day when she got a really bad, eyes-swollen-shut case of poison ivy. “I had to wait to go to the doctor until I had enough money in the bank,” says the 38-year-old Nia instructor.

Bergstrom is one of almost 5,000 people in Charlottesville and Albemarle who will qualify for Medicaid under the biennial budget Governor Ralph Northam signed June 7 that expanded health insurance coverage for nearly 400,000 Virginians who make too little to qualify under the Affordable Care Act or too much—or are too healthy—to qualify for Medicaid.

Her doctor’s visit and medication cost almost $400. “I think it’s pretty common to not have that amount of cash on hand,” she says.

And being in Massachusetts, which passed an individual health care mandate in 2006, people found it hard to believe she didn’t have insurance. “Everyone was arguing with me that of course you have health insurance, you must have forgotten your card,” she says.

Bergstrom makes around $7,000 or $8,000 a year, depending on how many classes she teaches. “My last wellness checkup was 11 or 12 years ago,” she says, and the last time she checked, health insurance would cost her around $500 a month. She lives in a household of three working adults who pay all their bills. “Health insurance is the only bill we cannot afford, or even imagine affording,” she says.

To House Minority Leader David Toscano, Medicaid expansion is a “really big deal” and one he’s worked on for the past five years.

Former Governor Terry McAuliffe made it a lynchpin of his administration, but he left office with no success in the face of a recalcitrant Republican-controlled General Assembly.

That all changed with the 2017 elections that swept 15 Democrats into the House of Delegates. “I began to see the possibilities after the election last fall,” says Toscano. Native son Northam won by nine points—“the widest margin of any statewide candidate. There’s always a number of reasons why, but of all of them I think the election was the biggest.”

Toscano represents all of Charlottesville and parts of Albemarle, and 3,400 people in his 57th District could be eligible for coverage, according to the Commonwealth Institute for Fiscal Analysis. And Toscano says as many as 10,000 could be eligible in the region, a “not inconsequential” number.

Virginia’s Medicaid program is one of the most restrictive in the country, with disabled individuals making more than $9,700 a year ineligible, as were poor, able-bodied, childless adults. The expansion allows people making 138 percent of the federal poverty level—$16,643—to be covered, with the federal government picking up 90 percent of the cost.

The expansion has a work requirement, which Tory Brown, spokesperson for Progress Virginia, says will lessen the gains in coverage and require an expensive bureaucracy to manage. “The work requirement was a bit of face saving for Republicans,” she says. “It’s not really that people are too lazy to work.” For people who have to work to get care but need care to be able to work, she calls it a “catch 22.”

Lena Seville, who ran for City Council in 2015 and has no health insurance, is worried that the work requirement could affect her eligibility for Medicaid coverage. “I’m in the middle of starting my own business,” she says, and whether she can get health insurance will depend on how the work requirements are written.

She says she’d hate to have to give up her volunteer work and new business to search for jobs, “which I already do and it’s hard to get a good fit.” Says Seville, “I was excited, but now I’m cautious. I may not have health insurance when it’s done.”

Virginia Organizing board member Emma Hale points out that a lot of people work full-time and don’t have health insurance. “We have a lot of places that don’t pay a living wage—the university is one of the worst offenders.”

People without insurance often delay treatment, she says, and Medicaid expansion could “prevent people from dying.”

Pam Sutton-Wallace, CEO of UVA Medical Center, doesn’t expect “measurably significant” changes from Medicaid expansion because nearly 30 percent of the hospital’s patients already are either on Medicaid, self pay or are indigent. “What we’re likely to see are more self-pay patients using Medicaid,” she says.

Her concern is whether the newly eligible will have access to primary care. “Some doctors aren’t accepting new patients,” she says. That, and whether emergency rooms will see a drop in the number of patients who wait until the last minute to seek care are “areas ripe for study.”

“I want to take preventive action so I don’t run into problems later on,” says Bergstrom. “We would gladly add in the cost of health care for me if it was a number remotely in reach, but we cannot spend nearly 80 percent of my income on one budget line item.”

Who benefits

The Commonwealth Institute for Fiscal Analysis estimated the number of people who would be eligible for health insurance coverage under Medicaid expansion by legislative district and locality. Here are the numbers for the districts of the four delegates who represent Charlottesville and Albemarle, and how they voted.

25th District

2,000 eligible in Western Albemarle, Augusta and Rockingham counties

Delegate Steve Landes voted no on expansion

57th District

3,400 eligible in Charlottesville and parts of Albemarle

Delegate David Toscano voted yes

58th District

3,100 eligible in parts of Albemarle, Fluvanna, Greene and Rockingham counties

Delegate Rob Bell voted no

59th District

3,300 eligible in southern Albemarle, parts of Appomattox, Buckingham, Campbell and Nelson counties

Delegate Matt Fariss voted no

Correction June 14: Emma Hale’s name was misspelled in the original version.

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In brief: Medicaid expanded, Building Bridges crashed and more

With so much going on in the executive branch, it's easy to neglect what's happening in the General Assemblyl as the session hits its . midpoint. File photo.

Medicaid expansion clears House

For Terry McAuliffe’s entire term as governor, Medicaid expansion for 400,000 uninsured Virginians remained out of grasp. Last week, after Republican Delegate Terry Kilgore broke rank in favor of expansion, the House voted 68 to 32 in favor, with local delegates Rob Bell, Steve Landes and Matt Fariss in the no column. The measure still has to clear the Senate, which did not approve expansion in its budget.

“For too long, we’ve allowed the Virginia way to be shouted down by a charlatan whose record doesn’t match his rhetoric, and right now, I’m done with fake politicians.”—Delegate Glenn Davis slams wannabe GOP U.S. Senate candidate Corey Stewart February 23 to a standing ovation in the House.

UVA event disrupted

Pro-Palestinian, megaphone-carrying protesters disrupted a Brody Jewish Center and Hoos for Israel event February 22 and may have violated UVA policies, says Dean of Students Allen Groves. The demonstrators were invited to join the Building Bridges panel, but chose to shout at participants instead, the Cav Daily reports.

DP escapes ax—this time

The Daily Progress is not affected by BH Media’s latest layoffs that cut 148 employees and leave 101 vacant jobs, according to DP publisher Rob Jiranek. Last April, the Berkshire Hathaway subsidiary canned 181 employees, including three at the Progress and 33 at the Richmond Times-Dispatch.

Statue stripper arrested again

Christopher James Wayne, the 34-year-old Richmond man charged with removing tarps from the city’s Confederate statues, picked up his third trespassing charge February 23. Police say he was between the orange barricade and the Stonewall Jackson statue in Justice Park. Wayne is barred from both Justice and Emancipation parks.

Park déjà vu

City Council will look at renaming Emancipation and Justice parks—again—after Mary Carey objected to the name Emancipation and collected approximately 500 signatures on a petition.

Crisis management

CHS students get four lockdown drills during the school year.

They hope it won’t happen here, but if it does, they want to be prepared.

On the heels of a Valentine’s Day massacre—the fourth most deadly school shooting in American history at Marjory Stoneman Douglas High School in Parkland, Florida—local schools are discussing their own crisis plans.

Students in city schools participate in four lockdown drills each year. Through an agreement with the Charlottesville Police Department, three armed resource officers and several unarmed community service officers rove the school district, primarily at Charlottesville High School, Buford Middle School and Walker Upper Elementary, according to Kim Powell, an assistant superintendent.

Among other security features, city schools have buzz-in systems at their front doors and interior doors that route visitors through the school’s main office. A crisis plan for each school, which is not available to the public, is reviewed and updated annually.

This spring, city schools will install new locks on classroom doors to ensure they all lock from the inside, something that’s already been implemented at all county schools.

Phil Giaramita, a spokesperson for Albemarle County Public Schools, adds that all school entrances are numbered, so first responders know exactly where to enter in the event of an emergency. Classroom door windows in county schools have also been coated with a protective material that’s harder to break.

About 14 Monticello High students walked out of their lunch period for 15 minutes on February 21 to protest gun violence, according to Giaramita. Both county and city schools are discussing preparations for upcoming national walkout events and marches, including the National School Walkout on March 14.

Charlottesville High is among the city schools that are patrolled throughout the day by three armed resource officers and several
community service members.