Nursing home and insurance affordability support heading to Virginia General Assembly


Nicole Pasia


Legislative recommendations to support insurance affordability, nursing homes, and home and community based services (HCBS) in Virginia will make their way to the General Assembly as a result of the Joint Commission On Health Care’s final meeting of the year. The Commission also voted on the selection of its 2022 studies topics.


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The Commission spent the last year studying three areas of Virginia health care and identified key issues and ways to address them. 

Health Insurance Affordability in the Individual Market

One subcommittee under the Commission focused on cost barriers within the individual health insurance market. Stephen Weiss, the commission’s senior health policy analyst, outlined their main findings from the study. He said as insurance premiums increased, younger and healthier Virginians were more likely to leave the market, and increasing outreach and navigation resources can keep them in.

The subcommittee presented seven policy options to the full Commission, including the creation of a public option. Ultimately, the Commission did not vote to recommend a public option, and instead voted on the following options: 

  • Direct the Exchange to develop a marketing and navigator plan and provide $3.7 million in general funds for FY2024 as support
  • Eliminate the smoking surcharge, which in some plans, added over $500 to their monthly premium
  • Model federal cost-sharing reductions for individuals up to 250% of the federal poverty level (around $32,200), and study the impacts on plan costs and enrollment

While the Commission voted on state policy options, Weiss reminded them that federal policy has been more impactful in reducing costs.

“There are multiple state policy options to improve affordability, but impacts are moderate compared to what’s going on with the current federal subsidies through the American Rescue Plan Act.”

Workforce Challenges in Virginia’s Nursing Homes

The Commission study found one in five Virginia nursing homes are experiencing staff shortages. Additionally, the workforce shortage disproportionately impacts Medicaid and Medicare beneficiaries, which make up 77% of nursing facility residents. 

The study suggested several policy options to address the workforce shortage, including adjusting hours of direct care for patients and increasing Medicaid reimbursement rates. Ultimately, the Commission approved the following seven recommendations: 

  • Direct Virginia Medicaid (DMAS) to create a plan to increase reimbursement for facilities with a high share of Medicaid patients
  • JCHC could introduce legislation to amend Virginia Code to require nursing homes to provide at least the number of expected total direct care hours and total RN hours based on CMS calculations. The Virginia Department of Health will assess compliance with the standard on at least a quarterly basis. 
  • Fund scholarships for students who commit to nursing facility work
  • Design a quality improvement program for nursing home staff support
  • Fund a formal evaluation of Value-Based Purchasing and its applications to nursing homes
  • DMAS plan to increase reimbursement for behavioral health needs
  • Nursing education funds for the Virginia Community Colleges System

Strategies to Support Aging Virginians in their Communities

A study on supporting Virginians who wish to age outside of assisted-living facilities found most of these individuals are outside of the Medicaid population, and that non-Medicaid funding has decreased over time. The study found home care and affordable housing to be the two highest needs for individuals in this community.

The commission approved the following policy recommendations: 

  • Create an amendment to the state Medicaid plan to include broader eligibility criteria for home and community based services (HCBS)
  • A budget amendment to increase state funding for HCBS
  • Provide a tax credit for family caregivers, a measure Governor-elect Glenn Youngkin has supported during his campaign 
  • The Commission could introduce legislation directing the Department for Housing and Community Development to update the current Housing and Supportive Services Interagency Leadership Team initiative to include older Virginians as a target subpopulation and develop proposals for increasing supportive housing for older Virginians

The Commission’s final meeting of the year also served as an opportunity for members to vote on study topics for 2022. Over the last few months, several potential topic ideas surfaced, including maternal mortality and related health disparities and an assessment of the state’s COVID-19 mitigation measures. The Commission unanimously voted to approve four studies:

However, should other health care issues gain priority during the 2022 Legislative Session, the Commission has the ability to reassess the topics after coming out of session. Commission Chair Del. Patrick Hope (D – Arlington) thanked commissioners and staff for the progress achieved so far. 

“I’m very pleased with the selection of people who are on [the Commission] … you just do a tremendous amount of work that you put into this. [It’s] very high-level, quality things that will live on, and I don’t believe will sit on the shelf. I think that will take a lot of action with the work that you’ve done.”