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Medicaid growth up to lawmakers

RICHMOND—Lawmakers, not the current or next governor, will be in charge of deciding whether Virginia expands Medicaid eligibility.

That’s thanks to a much-debated amendment to the state budget House and Senate legislators approved on Saturday, their last major act before adjourning from the regular session for the year.

The language creates a commission, appointed by the House and Senate money committee chairmen, to review any waivers the federal government grants Virginia as the year goes on.

But final authority on the expansion, said Del. Steve Landes, still reverts to the General Assembly. It gives legislators control over whether the expansion proceeds. Without the budget language, Landes said, the governor would have that control.

Democrats had been pushing to move forward with the expansion, and those in the Senate made their votes for Gov. Bob McDonnell’s transportation bill contingent upon expansion language.

Medicaid expansion discussions were born out of the 2010 Affordable Care Act, which promises federal funding for states if they expand their Medicaid eligibility rules.

For months, Virginia leaders have said they are unlikely to commit to the expansion, citing high costs and a lack of state control.

But in recent weeks, some lawmakers warmed to the idea, prodded by new, lower cost estimates, studies that say the expansion would create jobs, and the enthusiasm of business groups.

Others, like McDonnell, are still leery, afraid that federal promises of full or almost-full funding will evaporate, and that the state will be left with an expansion it can’t afford.

Both houses put language into their budgets requiring various waivers and concessions from the federal government before Virginia could move forward with the expansion. That became language about the commission.

Attorney General Ken Cuccinelli threw a wrench in those negotiations Friday night with an opinion saying it wasn’t constitutional for legislators to give control over spending to a sub-group. Budget negotiators reworked the language into something they think will pass legal muster, and both houses passed the budget with that language Saturday afternoon.

Republicans who oppose the expansion argued against it. In the Senate, eight Republicans tried to separate the Medicaid amendment from the budget conference report, but that can’t be done. They successfully got their objection written into the record, however.

In the House, Del. Ben Cline, R–Rockbridge, who had asked for Cuccinelli’s opinion on the constitutionality of that commission, said he still wasn’t satisfied that it left enough authority with the General Assembly to stop expansion.

“The language we have before us is about as clear as mud,” Cline said. “This is not a small issue at stake, it’s a very big issue.”

Others, though, said the Medicaid language would guarantee legislative oversight of the expansion, something lawmakers won’t have without that budget clause.

“Without something like this, the legislature has no input and no authority that is not generally something we like to cede to the executive branch,” said Landes, R–Augusta.

McDonnell told reporters Saturday night he will review the legislators’ language to make sure it truly requires the completion of some serious Medicaid reforms.

“I strongly oppose the expansion of Medicaid,” he said. “Medicaid is breaking the budget of Virginia. There will not be any expansion of Medicaid while I’m governor unless there are (reforms). It is going to be a long and arduous process to get the reforms.”

Medicaid expansion language was the biggest dispute between the House and Senate in what was otherwise an unusually calm budget process.

Legislators agreed to funding for the state share of a 2 percent pay raise for teachers, school support personnel, and some support for the cost-of-competing payments to Northern Virginia schools. That includes partial payments to school districts in the Fredericksburg region.

The budget deal also includes a new $30 million fund for school security grants, and $1.3 million for grants to help schools hire school resource and school security officers.

There is money for an additional 1 percent pay raise for college faculty, and to raise TAG grant awards to $3,100. The budget provides $400,000 for the Civil War Historic Site Preservation Fund. Lawmakers agreed to unfreeze five additional judgeships beyond the 15 proposed by McDonnell. Some of McDonnell’s ones were in the Fredericksburg-area circuits, although the additional five are not. McDonnell has several weeks to decide whether to sign, veto or amend about 900 bills passed by the House and Senate in this session. Legislators will return to Richmond in early April for a reconvened session to react to his changes.

Chelyen Davis: 804/343-2245