The next governor of Virginia will need to implement new work requirements for the Medicaid expansion population, but the state lacks the infrastructure needed to carry out the additional checks.
Neither candidate has released a comprehensive plan on how to reduce or avoid a backlog that could be caused by the requirements in a system that is already woefully inadequate.
Republican Lt. Gov. Winsome Earle-Sears’ campaign for governor did not respond when asked about her plan to tackle the new federally mandated requirements. Earle-Sears has seen backlash from her opponent and other Democrats after saying that the so-called “One Big Beautiful Bill,” which mandates the changes, “does so many great things.”
Former Democratic Congresswoman Abigail Spanberger said her administration would invest in infrastructure upgrades and would hire the additional personnel needed to address the changes.
“I will focus on keeping families, Veterans, and seniors from needlessly losing coverage by investing in digital infrastructure at the state level — including modernizing Virginia’s Medicaid enrollment and eligibility systems — to improve caseworkers’ ability to help Virginians navigate a burdensome system,” Spanberger said in an email from her campaign. “Additionally, I will direct my administration to invest in the people who help Virginians navigate changing eligibility requirements, resolve issues, and get the coverage they need — from the Commonwealth’s workforce to Medicaid navigators.”
Spanberger’s campaign did not respond when asked how the Democrat plans to pay for those infrastructure upgrades or additional staff. Nor did the campaign respond when asked for a comprehensive timeline of how Spanberger plans to implement those upgrades before the changes are slated to take place on Jan. 1, 2027.
The federally mandated changes to Medicaid expansion
Virginia’s Department of Medical Assistance Services, or DMAS, is managed by the state’s executive branch, which means the governor is responsible for the agency.
Congress passed the act dubbed the One Big Beautiful Bill on July 4. That bill included new work requirements and increased redeterminations of eligibility for Medicaid expansion enrollees. The additional criteria and checks will increase the workload for DMAS and Virginia’s Department of Social Services, according to an August presentation to the Emergency Committee on the Impacts of Federal Funding and Workforce Reductions. The cost of those changes is currently unknown, but it is likely that additional infrastructure and staff will be needed to carry out the additional work.
In the western half of the state, more than 178,000 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. Statewide, the number totals more than 630,000. Medicaid expansion allows caretaker adults and childless adults aged 19-64 with incomes up to 138% of the federal poverty level to access the program. For a household of one, 138% of the federal poverty level is an annual income of $21,597.
Under changes mandated by Congress, members of the Medicaid expansion population will need to provide proof to the state that they are participating in work, community service or education programs for at least 80 hours each month. The state will also need to increase the frequency of redetermination of benefits for expansion enrollees from once a year to every six months. According to the law, the federal Department of Health and Human Services is required to release its final rule for enactment of the new policies by June 2026, which provides roughly six months for states to cobble together the resources needed to implement the changes.
DMAS’s infrastructure is already woefully inadequate
A 2024 state-commissioned study found that the state’s eligibility systems are outdated and inefficient, making upgrades costly and difficult. The state is ranked among the 10 slowest in the nation for processing Medicaid applications. With the new federal rules requiring states to track enrollees’ work hours and conduct twice as many eligibility checks each year, Virginia is facing a potentially steep price tag to comply.
Virginia uses a decentralized model for processing applications. The 120 local agencies manage eligibility determinations, but each faces different levels of funding, staffing and training. Many are overwhelmed, the study found.
The state’s outdated IT system compounds the problem. Built in the late 1990s, it lacks flexibility, cannot easily be updated and is not user-friendly, the study said. More applications must be processed manually, creating an even heavier workload for local staff. The estimated cost to update the system has a wide range, from $10 million to $250 million, according to a recent study by the U.S. Government Accountability Office. That estimate does not include ongoing operating costs, however.
The new federal requirements will demand that Virginia speed up eligibility processing, prevent wrongful terminations and handle larger caseloads. The state has no system in place to process the paperwork tied to the new work requirements. The increased eligibility checks will add yet another layer of strain to an already overburdened system.
Federal regulations have required states to process Medicaid applications within 45 days since the Affordable Care Act was implemented in 2010. Last year, 19% of applications in Virginia exceeded the 45-day limit, and only 21% were processed within 24 hours — far below the national average of 44%. The federally mandated increased workload could lead to a backlog of applications.
If these processing times worsen, the federal Centers for Medicare and Medicaid Services could place Virginia on a federal corrective action plan, which may carry financial penalties.
The Earle-Sears campaign did not respond when asked if she had a plan or would like to share a statement to ease the anxiety felt by expansion enrollees in light of the new law.
“In the aftermath of this reckless law, I believe Virginia’s Governor should be preparing the Commonwealth for the many challenges ahead — not dismissing the harm that this new law will cause,” Spanberger said in an email from her campaign. “I know there are steps we can take right now to save Virginians money, and I rolled out my Affordable Virginia Plan to focus on preventing Virginians from falling into medical debt and lowering healthcare costs. As Governor, I will always stand up for Virginians’ health, safety, and financial security.”
Spanberger’s campaign declined to make the candidate available to Cardinal News for a short follow-up conversation. Earle-Sears’s campaign did not respond when asked if the lieutenant governor would be available for a short conversation.
To see where the candidates stand on other issues, see our Voter Guide.
