After initial delay, state developmental disability waiver program humming along

(The Center Square) — After a push from Gov. Glenn Youngkin to provide developmental disability waiver slots to everyone on Virginia’s priority one waitlist, slot assignments should be on track by the end of 2024.

In Virginia, individuals with disabilities can qualify for Medicaid waivers to obtain services historically only provided by institutions. Those on the priority one waitlist are expected to need services within a year.

Representatives from the commonwealth’s Department of Behavioral Health and Developmental Services gave an update Tuesday to the state House Appropriations Committee on the waiver program, revealing progress. However, due to an initial delay, the department is currently behind on filling slots.

“The Centers for Medicare & Medicaid Services approved our waiver slots late in July, which put us about a month behind in terms of starting to allocate this fiscal year’s slots,” said Heather Norton, acting deputy commissioner for community services and assistant commissioner for developmental services.

But already, five of Virginia’s 40 community services boards – the organizations through which the department first assigns slots – have assigned slots to everyone on their priority one waitlists. Twenty-three boards have 27 or fewer people on their priority one lists, according to Norton.

In December, Youngkin announced increased program funding in the state’s biennial budget to provide waivers to the 3,400 Virginians on the priority one waitlist. The final budget language stipulated that the department would fill those slots every quarter over two years.

As of Tuesday, the department had 130 slots left from the first quarter (July-September) and just 28 of 437 slots filled for Q2. But Norton remained optimistic.

“Thirty-two out of the 40 community services boards have held their slot assignment meetings [for Q1]. We have eight CSBs who will have their slot assignment committees this month, and then all Q1 slots will be allocated to individuals,” Norton told the committee.

So far, five of 40 boards have held their meetings for the second quarter, but all other boards are scheduled to hold their slot assignment meetings by the end of December.

“We’ll be back on track for our quarterly allocation” by the end of the second quarter, Norton said.

The House money committee heard the department’s waiver program update a day after the latest Senate Finance and Appropriations Committee meeting, during which Virginia Medicaid’s CFO explained that Medicaid enrollment following the COVID-era relaxed eligibility requirements has wildly exceeded projections and will need more state funding.

Committee member Del. Mark Sickles, D-Fairfax, doesn’t necessarily see that as a bad thing since programs like the developmental disability waiver program benefit from it.

“I just want to emphasize that when people say Medicaid spending is going up, this is what they’re talking about. It’s not that the program’s out of control. It’s families getting services that didn’t have them before,” Sickles said.

Serving more disabled Virginians isn’t just a matter of handing out more waivers. Provider compensation has to be strong enough that providers are willing to participate, and the state’s workforce has to be able to meet service needs. That’s why the General Assembly included funding for a 3% increase in waiver reimbursement rates for the first year and another 3% raise for the second year.

“We’re very grateful for the 3% increase. It has been helpful,” Norton told the committee, noting that though the number of provider locations has grown 10% since January, the need persists.

“We are still tracking a need related to nursing services, behavioral services, and more integrated community services,” Norton said.