In response to these new patient costs, use of medical services has declined or been delayed, long-term medical costs have risen as preventative medical visits have fallen, substantial numbers of people have been removed from the program or locked out of coverage, debt and financial hardship has increased, and unhealthy behaviors have increased. ![]() A handful of states have imposed similar financial requirements on low-income Medicaid enrollees to what Virginia proposes. Virginia is pursuing this policy even though research shows that Medicaid premiums and copayments make it harder for low-income people to receive the care they need and in many cases fail to lower costs. Under this waiver, an estimated 42,000 low-income Virginia Medicaid enrollees would be subject to premiums and an additional copayment. Most current adult Medicaid enrollees in Virginia are already subject to some copayments for services in the range of $1 to $3 per visit. If these enrollees fail to make these payments, they can be locked out of their health coverage until they are able to afford payments again and will face debt collection. That means new costs would be applied to families with incomes between around $12,000 for an individual on the poverty line, up to $35,000 for a family of four at 138 percent of the poverty line. ![]() The Virginia budget also instructs the state to include in its waiver request a provision requiring certain Medicaid enrollees with incomes between 100 and 138 percent of the federal poverty line to pay premiums and copayments in order to access their coverage. Since then, much attention has been given to a provision requiring the state to apply for a waiver from the federal Centers for Medicare and Medicaid Services (CMS) to impose a work requirement on certain low-income Medicaid enrollees in Virginia. The Virginia General Assembly passed a budget that directs the state to expand Medicaid as part of the Affordable Care Act (ACA) in June 2018.
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