Virginia state lawmakers on May 30 passed a state budget amendment that includes extending Medicaid coverage to an additional 400,000 individuals by Jan. 1, 2019. The state will be the 33rd to expand Medicaid under the Affordable Care Act (ACA), and industry experts are eyeing the proposal for its potential to push expansion in other Republican-controlled holdout states.

The Virginia Dept. of Medical Assistance has 45 days to submit a State Plan Amendment to CMS to expand Medicaid coverage to individuals with annual incomes of up to 138% of the federal poverty level pursuant to the ACA and 180 days to submit a demonstration waiver application seeking work requirements and other modifications to the Medicaid program.

“What I hope the [Trump] administration and others take away from [Virginia] is that the expansion is a very valuable tool to provide coverage to hundreds of thousands of lives that may be uninsured but aren’t free because they are going to seek health care,” says Jeff Myers, president and CEO of Medicaid Health Plans of America.

Myers says plans in Virginia have been preparing for expansion for years and have been actively engaged at looking at the needs of this new population and how they’re going to provide services. “And I think Virginia is going to be a loud signal to states that haven’t expanded — Florida, Texas, North Carolina and others — that maybe this is a way to do this expansion,” he suggests.

At least three other states — Idaho, Nebraska and Utah — at press time were advancing ballot initiatives to expand Medicaid.

Myers adds that it will be interesting to see what happens in North Carolina, which plans to transition from fee-for-service to managed care but has not expanded Medicaid. At press time the state was one of nine states that had pending waivers seeking to add work provisions to their Medicaid programs.