Cracks in Medicaid expansion leave some Virginians without care

Macy Pressley
Contributing Writer

Many Virginians will remain without access to healthcare in January, despite the General Assembly passing Medicaid expansion in May according to the Virginia Health Care Foundation.

Though the expansion is expected to bring healthcare to 400,000 Virginia residents, the work requirement — currently up for public comment — may present a challenge to residents with poor health or disabilities. Furthermore, the expansion does not address issues some may have with the affordability of transportation, co-pays and prescription drugs.

Altogether, about 323,000 Virginians will still not have health care come January, according to the Virginia Health Care Foundation.

Many will be impacted by the work requirement, which mandates that Medicaid recipients work on community engagement activities for 20 hours a month for the first three months. While the requirement is not anticipated to take effect until after the expansion period in January, the mandated hours would increase in stages over time. It would eventually reach a maximum of 80 hours a month, according to the Virginia Department of Medical Assistance Services.

The work requirement, however, would not be implemented right away, according to Deborah Oswalt, executive director of the Virginia Health Care Foundation.

“There is no work requirement in effect at this time, nor is there likely to be one for some time,” Oswalt said. “The state has to submit a waiver request and then the feds have to review it.  This has been a lengthy process for other states. Once its approved, it will take the state time to establish the rules and processes for it.”

A September story by the Washington Post addressed the work requirement as well, explaining that “the plan will undergo a 30-day public comment period, with explanatory hearings held around the state, before being finalized and submitted in early November.”

Another group who will still lack access to healthcare is immigrants — both documented and undocumented — according to Tiffany Green, a VCU professor of health and behavioral studies.

“Legal immigrants cannot access most public benefits for at least five years,” Green said. “So that is going to include Medicaid expansion.”

She also warned of the consequences for not having care.

“Access to healthcare is a really critical thing,” Green said. “It means that we can address issues that arise, like chronic disease issues, before they get worse. Illnesses such as diabetes are particularly important to stay on top of, and so not having access to care means that sometimes you go to medical care [a] little too late.”

Daily Planet Health Services works to address these concerns. The free clinic has treated nearly 38,000 Richmond residents. Beth Merchent, the clinic’s CEO, understands how hard it can be for some of their patients to access care.

“If you have poor health, it’s gonna be hard to get a job that pays a fair wage, so you’re not gonna have secure housing, you may not have transportation,” Merchant said. “It’s a whole cycle.”

Advancement Coordinator for Daily Planet Susan Sekerke said she remains confident they will be able to overcome these challenges and continue to provide care.

“We’ll be here for people,” she said. “We are really the one place, regardless of your housing status, your financial situation, or your insurance status [that] you can come and get healthcare services from us when you need it.”

While Gov. Ralph Northam acknowledges the current plan is not perfect, he said he is proud of the state’s ability to overcome partisan divide and pass a bill for the benefit of Virginians.

“As a doctor and a public servant, I believe making sure all Virginians have the access to the care they need to be healthy and productive is both a moral and economic imperative,” Northam said in a statement June 7. “We can get a lot done if we continue to work together in good faith, with our goal always being to do what’s best for Virginia. We still have important work left to do and I look forward to more big accomplishments that will improve the lives of all Virginians.”

Open enrollment for Medicaid began Nov. 1 and will close Dec. 15. However, people who fall under certain circumstances may be eligible to apply year-round.

“Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you qualify for a Special Enrollment Period,” a website says. “You’re eligible if you have certain life events, like getting married, having a baby, or losing other health coverage.”

To find out more information, visit

This story was updated Nov. 19, 2018 with the following corrections:

Originally, it was said that “enrollment for Medicaid began Nov. 1 and will close Dec. 15.” This was misleading. Open enrollment for 2019, according to, will end Dec. 15, but special enrollment is available year-round. Additionally, the comments by Deborah Oswalt and reference to the story by the Washington Post were added in order to further clarify the Medicaid work requirement. Lastly, the interview with Richmond resident Tracie Deinhardt is now omitted. Deinhardt alluded that, because she has cancer in her left knee, the government would not consider her for health insurance. The inclusion of her interview was misleading because that is not necessarily the case, and it may discourage people in similar situations interested in applying for Medicaid from potentially doing so.

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