Skip to main content

Achieving value and health equity on a tight budget.

This lofty goal was the central focus of discussions at the Virginia Association of Health Plans (VAHP) 2023 Annual Meeting. Conversations revolved around statewide and national health care issues, regulatory updates, and Virginia’s political environment, highlighting the importance of this goal.

The meeting featured insightful presentations from state and federal health and insurance agencies, policy advisors, and representatives from other state agencies and associations.

Let’s dive into key insights from the most impactful sessions.

Understanding the benefits associated with Virginia transitioning to a State-Based Exchange

Health plans are expected to benefit from Virginia’s transition to a State-Based Exchange (SBE).

The meeting featured an update on Virginia’s Health Benefit Exchange (HBE) implementation. Keven Patchett, from the State Corporation Commission (SCC), shed light on HBE’s goals for the upcoming 2024 Open Enrollment (OE) and influx of Marketplace enrollments during the Medicaid unwinding process.

The transition to the SBE, set to begin on November 1, 2023, aims to:

  • Foster meaningful collaboration
  • Tailor consumer outreach and education
  • Cater to the needs of Virginians
  • Improve coverage transition from Medicaid to the Marketplace
  • Reduce the number of uninsured individuals

Industry experts stressed that creating a network that includes carriers, agents, navigators, and community members is essential for achieving these goals.

Virginia’s reinsurance program and potential challenges ahead

Budget protocols may result in rising premiums.

A session led Scott White, Commissioner of the Bureau of Insurance, focused on the purpose and implementation of Virginia’s reinsurance program, as well as its financial implications.

Reinsurance programs have gained popularity in several states as a means to reduce premiums in individual health insurance markets. These programs leverage 1332 waivers to secure financing.

The presentation highlighted that the reinsurance program in Virginia is funded through a combination of federal and state funds. The program was passed in 2021, and the budget is earmarked two years in advance.

The main challenge discussed during the session revolved around funding for future years. The legislative process poses difficulties as legislators prefer passing budgets that align with the fiscal period in question. Without obtaining approval for future funding, there is a risk of significant premium rate increases, potentially reaching up to 20%.

It was noted that currently, 17 states have reinsurance programs in operation, emphasizing the growing adoption of this strategy across the nation.

Overall, the session provided valuable insights into Virginia’s reinsurance program and the potential challenges it faces, particularly in securing future funding.

Navigating Medicaid unwinding and the transition between coverage types

Millions are at risk of losing coverage.

DMAS officials Cheryl Roberts and Sarah Hatton provided insights into the ongoing changes in Virginia’s Medicaid program. With 2.1 million individuals on Medicaid in Virginia, including nearly 900,000 children, the program plays a crucial role in ensuring access to healthcare for vulnerable populations.

The overarching goals of Virginia’s Medicaid program were outlined as member-centeredness, innovation, and accountability.

Virginia’s Medicaid unwinding plan includes a 3 phased approach to transition members from Medicaid to Marketplace:

  1. Support and enhance messaging from DMAS (Department of Medical Assistance Services) and CMS from now until August
  2. Provide additional messaging and education regarding Virginia’s transition from August to November
  3. Conduct direct consumer outreach and focus on VA Marketplace messaging from November onwards

Alongside the phased approach, Roberts and Hatton presented five strategies aimed at accomplishing the department’s goals related to Medicaid unwinding:

  1. Augmented investments in marketing outreach and education
  2. Implementation of direct consumer assistance programs
  3. Utilization of consumer-level data to develop targeted outreach plans and inform policy decisions
  4. Phased unwinding of SEP (Special Enrollment Period), with the first phase concluding on March 31st, 2023, and the second phase on July 31st, 2024
  5. Alignment with Virginia Medicaid’s 90-day reconsideration period, commencing on January 1, 2024

Anticipating Virginia’s Medicaid managed care re-procurement

A successful implementation is achieved through experience.

As Virginia prepares for its upcoming Medicaid managed care re-procurement, industry leaders and stakeholders look to understand what to expect and how to align their responses accordingly. Matt Salo, Founder and CEO of Salo Health Strategies, shares insights on recent Medicaid managed care procurements in other states.

Here are a few key proposal areas that managed care organizations (MCOs) must consider:

  • Commitment to addressing disparities and ensuring equitable access to healthcare services
  • Driving delivery systems in community-based organizations and payment reform
  • Working under profit caps and achieving strong Medical Loss Ratio (MLR) performance
  • Expanding into other lines of business

As Virginia prepares for its Medicaid Managed Care Re-procurement, understanding the expectations and priorities outlined by industry experts will lead to higher quality bids.

In conclusion, the 2023 VAHP Annual Meeting served as a platform for industry leaders, policymakers, and experts to discuss critical issues in Virginia’s ACA and Medicaid landscape. By addressing challenges head-on, Virginia is positioning itself to enhance health equity, improve access to care, and drive value in its healthcare programs.

If you have any questions or would like to discuss the topics covered at VAHP, feel free to reach out to the author of this recap, Marc Bryant, at