A special session of the Virginia General Assembly will likely be called if the federal government makes cuts to Medicaid funding, state Sen. Creigh Deeds, D-Charlotteville, said Thursday.
“We’re going to have to go back into special session in that circumstance and figure it out,” he said during a news conference in Richmond called by The Commonwealth Institute, SEIU Virginia State Council and Protect Our Care.
The power to call a special session ultimately lies with Gov. Glenn Youngkin if the General Assembly officially adjourns for the year, but there are parliamentary maneuvers legislators could use to stay in official session even after they finish work and go home.
With President Donald Trump back in the White House, and Republican majorities in both houses of Congress, conversations have begun in Washington about cutting Medicaid funding. Such cuts could trigger a state law that would reverse Virginia’s expansion of the insurance program if federal funding drops by even 1%, leaving hundreds of thousands of Virginians without health insurance.
More than 630,000 Virginians have received health care coverage under Medicaid expansion since the commonwealth implemented the program in 2019, according to data from the Virginia Department of Medical Assistance Services. An estimated 178,000 of them are in the western half of the state.
If the federal government’s share of funding Medicaid expansion in Virginia is cut from 90% to 50%, that would leave the state to make up for a new $2.5 billion cost annually, Deeds said. The federal government paid about $6.2 billion in fiscal year 2023 to fund Medicaid expansion in Virginia. The state was responsible for about $693 million in the same time frame.
“I don’t know where that money will come from,” Deeds said. “It is a federal responsibility. We’ve got to hold their feet to the fire and make sure the federal government addresses this, but this is something that is going to affect real Virginians.”
Representatives Morgan Griffith, R-Salem; Ben Cline, R-Botetourt County; and John McGuire, R-Goochland County, did not respond when asked Thursday whether they support or oppose rescinding Medicaid expansion. Virginia’s two senators, Tim Kaine and Mark Warner, both Democrats, have previously stated that they would fight efforts to rescind expansion.
Senators seek to remove trigger language
Deeds and Sen. Ghazala Hashmi, D-Chesterfield County, introduced budget amendments this year that would remove the trigger language from state law. Under the amendment, should the federal match rate change, a legislative committee would be established to consider ways to adjust to the federal action while preserving access to health coverage for as many Medicaid enrollees as possible.
Deeds said it’s likely an iteration of the amendment will be included in the Senate’s final budget proposal, but the language might change between now and Sunday, when that proposal is slated to be finalized.
“Dealing in hypotheticals is very difficult,” he said.
Expansion of the Medicaid program was introduced in the Affordable Care Act, passed by Congress and signed by then-President Barack Obama in 2010. Since then, Medicaid expansion has been adopted on a state-by-state basis. As of November, 41 states had adopted it.
Del. Terry Kilgore, R-Scott County, was one of a number of General Assembly Republicans who broke from the party to vote to expand Medicaid in Virginia in 2018. In the end, 36 House Republicans and four Senate Republicans voted for the biennial budget that established Medicaid expansion in the state. Including the trigger language in the bill was a main driver in attracting Republican support. That language could lead to a rollback of health care coverage for people on Medicaid through expansion, should the federal cost share drop below 90%.
Kilgore has said that he doesn’t think that Republicans in Congress will vote to cut funding for Medicaid.
“I don’t see much appetite for that in folks I’ve talked to,” he said.
Rural hospitals rely on Medicaid expansion
“During the recent presidential campaign or since then, the Elon Musk folks have said they’re going to take as much as $2 trillion in federal spending,” Deeds said. “The president has said that’s not going to be Medicare or Social Security — well, the only other place it can be for a meaningful amount of money is Medicaid.”
Many rural hospitals depend heavily on Medicaid expansion patients to stay financially viable. Without this funding, these hospitals could face financial strain, risking the services they provide to rural and underserved communities.
“Leading up to expansion, hospitals were mostly cutting back on services,” said Deepak Madala, director of Virginia’s insurance marketplace called ENROLL Virginia.
For example, about 39% of the patients who stay at Russell County Hospital in Lebanon for 24 consecutive hours or more are covered by Medicaid, according to data from Virginia Health Information. At Twin County Regional Hospital in Galax, the number is 33%. At Carilion Roanoke Memorial Hospital, 26.4%.
The federal government currently covers 90% of Medicaid’s operating costs, with Virginia responsible for the remaining 10%.
Before Medicaid expansion, Virginia had one of the highest rates of uninsured residents in the country. In the year prior to expansion, about 27.6% of residents under age 65 lacked health insurance. That’s about 5 percentage points above the national average, according to data from the National Institutes of Health.
