Virginia is expected to become the 33rd state (plus the District of Columbia) to expand Medicaid under the Affordable Care Act (ACA) following the passage of a budget by the Virginia legislature. The expansion will take effect on January 1, 2019 and it is expected to provide coverage to close to 400,000 individuals. Prior attempts to expand Medicaid in Virginia by former Governor Terry McAuliffe were stifled by an unsupportive legislature. The legislation expanding Medicaid passed with some Republican support, which was conditioned on the inclusion of an 1115 demonstration request containing a work or community engagement eligibility requirement. The requirement will be gradually escalated, requiring at least 20 hours of work or community engagement a month beginning 3 months after enrollment and 80 hours after 12 months of enrollment. Under the ACA the federal government will cover 90% of the cost of the expansion population, with the state responsible for the remaining 10% of funding. Virginia will implement a tax on hospitals in order to pay for the state share of expansion funding.
Utah’s Lieutenant Governor Spencer Cox announced on May 29 that a referendum to expand Medicaid will be on November’s ballot. Proponents obtained 147,280 signatures in support of a ballot initiative to expand Medicaid, far exceeding the 113,143 signatures required. If passed, Medicaid expansion is expected to lead to coverage of 150,000 people in Utah. Last November, Maine became the first state to expand Medicaid by ballot initiative. Proponents have filed a lawsuit to require Governor LePage to implement the expansion following his refusal to submit a state plan to CMS this spring (HL Pulse summary here).