Virginia requests $273.2 million from increased FMAP for HCBS spending

The Virginia Department of Medical Assistance Services (DMAS) submitted its $273.2 million spending plan for home and community based services (HCBS) to the Centers for Medicare and Medicaid Services (CMS) last month, which will draw funds from 10 percent increase in Federal Medical Assistance Percentages (FMAP) under President Biden’s American Rescue Plan Act (ARPA).


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DMAS estimated the Commonwealth is eligible for $26.8 million and $41.5 million in quarterly funds for its fee-for-service and managed care programs, respectively, assuming the increased FMAP will last until March 21, 2022. The funding would support approximately 275,000 Virginians who benefit from the state’s Medicaid managed long-term services and supports (MLTSS) program.


Image: Virginia Department of Medical Assistance Services


DMAS identified four areas regarding HCBS to invest increased FMAP funds:

  • Ensuring access to HCBS providers and support services, including incentives to expand underutilized services such as waiver and HCBS behavioral health supports
  • Initiatives to improve care coordination and member experience within HCBS services
  • Developing and improving technology and HCBS infrastructure
  • Developing HCBS workforce through provider training, recruitment and retention, and behavioral health support

In June, DMAS used the state’s town hall forum to collect input from HCBS stakeholders on potential uses for the FMAP funds, relating to the four target areas outlined in the spending plan. DMAS received 165 public comments from various silos, including the Virginia Board for People with Disabilities, the Virginia Association of Community Service Boards, members, providers, and managed care associations. The comments suggested three areas to focus spending:

  • Retention/recruitment of provider staff: Specific programs mentioned that need assistance include private duty nursing, the Department of Social Services, behavioral health and Addiction and Recovery Treatment Services (ARTS), and the Developmental Disabilities waiver. 
  • Access to care; particularly in the behavioral health sector. Commenters requested more support for physiatrist, psychologists, and Medication-Assisted Treatment within ARTS.
  • Policy Related Requests: Some comments requested changes to current policies, such as reimbursements for spouses and parents of minor children, more respite hours, and increasing the amount of Supplemental Security Income.

The letter to CMS included a section detailing the spending plan’s role in the upcoming special legislative session, which will address ARPA appropriations. The letter specifically mentions budget language that will support Developmental Disability Waiver (DDW) HCBS providers: 

“It is the intent of the General Assembly that from any additional federal funding that is provided to the Commonwealth to offset the economic impacts from COVID-19 that a portion of such funding shall be set aside and allocated to provide support payments to Medicaid Developmental Disability Waiver providers that have experienced a significant disruption in operations and revenue during the COVID-19 public health emergency (PHE).”