[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6709499,"mediaKeyId","5431231-1f8ac6e8ae0378f0ad53752185ab1dc4","parentId",5431231,"title","Children's Services Act spending rebounds; private special-education placements remain main cost driver","audioSeconds",2059,"startMs",2239000,"endMs",4298000,"viewUrl","/Search/View?dp=1&key=5431231-1f8ac6e8ae0378f0ad53752185ab1dc4&start=2239&end=4298","thumbnailUrl","https://assets.pipeline.soar.com/5431231-1f8ac6e8ae0378f0ad53752185ab1dc4/thumbnail_2239000.jpg","articleUrl","/articles/6709499/Virginia/Childrens-Services-Act-spending-rebounds-private-special-education-placements-remain-main-cost-driver","mediaUrl","https://secure.pipeline.soar.com/6709499-df7f73cf667fa926166811746ab64ba1/orig.mp4?Expires=1771111725&Signature=BaxnATuDaFyfe9g2O5rHBb9E9e-RSrOwnDHmm6RjqRMtwI0~fsbSNRe2IisCsl1Ee8tnPVe1mUKS~EXhC6VAIUwR1f~sRgT-LGNvXO5XJMlHoyzKvcn9FAjlRO8IekyxgPpZ49Q3TaGMNfdaU8~2eTZd2icyLxLpZA3gWA97WHqL2Vr8B~30RmR6877hRTNqWHxGvhIsk~6AYRGS6~AgXRqopp0RH5slpSzg-zkLbOPoVUIHYm4lbnWCbGEqzbk65DFkbo7n7w~I8BcINEEdUjWY8FVvQs2ORYX5kcrOw5PofFNN9g9RO5-TPUyb2qdk27cHrzme~LDmSs6nTONrrw__&Key-Pair-Id=KUT5TJCACFTXG","author","Virginia Legislature","date","2025-07-15T00:00:00Z","article","Scott Rainier of the Office of Children's Services briefed the Joint Subcommittee for Health and Human Resources Oversight on trends in the Children's Services Act (CSA), saying state and local expenditures and the number of youth served have begun rebounding after pandemic-era declines.

Rainier said CSA is a \"state supervised, locally administered\" program that is mostly funded with state general funds and local matches; he said federal dollars in the CSA budget are limited and that for most services the state must provide sufficient funding for approved demand. He told the panel CSA is largely nondiscretionary and that roughly two-thirds of CSA funds come from the state while about one-third is local share; local match percentages vary by jurisdiction.

The presentation included several quantitative details. Rainier said the program served roughly 16,000 youth and families and that preliminary data for FY25 showed an expenditure increase of about 13% over FY24. He said private special-education placements represent about 30% of youth served but account for about 45% of CSA spending because private special-education placements are costly. Residential treatment is a small share of youth but a larger share of spending because of high per-child costs.

Rainier and members discussed drivers of growth. He cited increases in private day special education, community-based services, group homes for youth in foster care and rate increases tied to market conditions and Medicaid benchmarks. He explained that foster-care-related costs are largely determined by local department of social services placement decisions and that a suspension and reinitiation of certain Family First Prevention Services Act draws had shifted some federal funding responsibilities. Rainier said that if DSS completes required accreditations and requirements, federal title IV-E draws could be reinitiated, which would reduce local and state CSA burden for those placements.

The office noted the General Assembly capped rate increases for private special-education placements at 5% in FY26; Rainier said that cap addresses rate growth but does not reduce demand-driven cost increases. He also said CSA has a relatively small non-sufficient set-aside (about $14 million) that is not fully utilized and is not the major driver of spending.

Several legislators asked what localities are doing to reduce referrals to expensive private placements; Rainier said some school divisions have invested in in-school supports and that regional public special-education programs are a lower-cost alternative. He also told members CSA would provide follow-up materials showing expenditure trends and the effect of the 5% cap.

Rainier concluded by offering potential containment options for committee consideration, including unit or lifetime limits on services and maximizing federal funding avenues for qualified residential treatment where appropriate. Lawmakers requested additional data and trend breakdowns by locality and service type.","mediaType","Video","parentTitle","Joint Subcommittee for Health and Human Resources Oversight - SR 1300","oneSentenceSummary","Office of Children's Services staff told the subcommittee that CSA spending and caseloads are rising again after pandemic declines, driven largely by private special-education placements and foster-care residential needs; the office urged monitoring and possible containment options.","taxTitle","2025 Legislature VA, Virginia","taxId",77687,"location","Virginia","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6709507,"Subcommittee hears DMAS plan to implement Medicaid changes and warns of large hospital payment cuts",1364,184000,1548000,"/Search/View?dp=1&key=5431231-1f8ac6e8ae0378f0ad53752185ab1dc4&start=184&end=1548","https://assets.pipeline.soar.com/5431231-1f8ac6e8ae0378f0ad53752185ab1dc4/thumbnail_184000.jpg","/articles/6709507/Virginia/Subcommittee-hears-DMAS-plan-to-implement-Medicaid-changes-and-warns-of-large-hospital-payment-cuts","https://secure.pipeline.soar.com/6709507-e0420db56803634b6b581e58f0c5f099/orig.mp4?Expires=1771111725&Signature=kSx8o~YMfVsFMlX3pCg23p3L~Fv24viNgbmLmyIFtga97zCKDdfT8YxlJVU8jVA78xEQ1p5EVpeOiOG-Y2fWbZUYXQ4Z5IeeSvsgCVuKSKfYCDMGN1j6Pa0ZaBslJEDqA2lrh5C5T70-PBe~qCioQgOGACiTfHjpDBfv6Q~J4xr51UFYJSMZAqXNdUgfZ7q3kJmO0cJolhwXv-vlTi5PqYclsOpOD2ru5VuEkMfmMTIArSOX3ZSc~rsQZ9Xdb6Gppzy0kPzWLzaLNs8fMkf~7W1Gg6oFQd9h3KaxeYMjoGs8JL6kn3z61yhvFvg9adfFDLpojUFLeOZ-mRkRZxrdzA__&Key-Pair-Id=KUT5TJCACFTXG","Cheryl Roberts, director of the Department of Medical Assistance Services, told the Joint Subcommittee for Health and Human Resources Oversight on Tuesday that the agency is preparing to implement a package of changes to Medicaid eligibility, enrollment and benefits in the new federal/state law but is still awaiting key CMS guidance.

Roberts said the changes affect the expansion population (about 600,000 people), foster care and other subprograms and will require systems work, new reporting and outreach. \"This is going to be a collaboration,\" she said, noting the Governor's office and CMS will be involved in implementation. Roberts told the committee that expansion eligibility will move to six-month redeterminations, that states must use additional data sources to detect duplicate enrollment, and that the federal death master file must be checked quarterly to remove deceased individuals from rolls.

The subcommittee heard several specific implementation details that will affect members, providers and vendors. Members may change managed-care plans through Sept. 25, Roberts said. Retroactive coverage will be shortened: expansion members would receive one month of retroactive coverage and other Medicaid populations two months, down from three months currently. The new law also reinstates cost-sharing for expansion members with a possible maximum of $35 per month.

One of the most consequential provisions discussed was a community-engagement (work) requirement that would begin Dec. 31, 2026. Roberts said expansion enrollees would need to participate in one or a combination of work, education or community service for 80 hours a month, but CMS must provide definitions and operational guidance before Virginia can implement the requirement. \"We do not have the definitions yet,\" Roberts warned, and she said MCOs may not perform the calculations because CMS views that as a conflict of interest.

Roberts described other changes: a new option to allow some people to receive home- and community-based services without meeting nursing-home eligibility via a waiver; a federal \"maternal health transformation\" program that would provide $100 million annually to Virginia for five years with additional competitive funds; and increased state monitoring and contract addenda to hold MCOs to promised services.

Chris Gordon, introduced as a DMAS CEO-level official, briefed members on the fiscal side of the federal legislation that limits provider taxes and caps state-directed supplemental payments. Gordon said Virginia currently taxes hospitals at 6% of net patient revenue, which he said yields about $1.6 billion; roughly $650 million of that is used to fund the state share for expansion while the remainder supports supplemental payments to hospitals. Under the new federal rules, states will be restricted to directed payments at no more than 100% of Medicare and certain rate assessments must be reduced; Gordon testified that shifting down to Medicare-based caps and an annual 10% reduction in supplemental payments will reduce hospital-directed payments substantially and, over 14 years, could total about $26 billion in reduced payments to hospitals and related providers.

Gordon said the impact would be felt across private and public hospitals, naming the large academic public hospitals paid at higher multiples of Medicare (UVA and VCU) and other systems that receive supplemental payments. \"That is the biggest impact,\" he said, describing cuts to payments now made above Medicare rates. He warned the reductions would have macroeconomic effects — lower employment in health care, fewer services and potential strain on safety-net providers.

Committee members pressed DMAS on cost estimates. Roberts and Gordon said DMAS is preparing cost models but must wait for CMS guidance to finalize many figures. Roberts also said DMAS had taken steps in procurement and contract monitoring for Cardinal Care managed care earlier this year, combining long-term and acute care functions and consolidating foster-care enrollment into a single plan to improve continuity of care.

The subcommittee adopted an electronic meeting policy and conducted organizational votes at the start of the session (nominations for chair and vice chair) by voice vote.

The agency committed to returning with more detailed estimates on administrative costs, the potential budget impact of work requirements, and numbers on changes to the emergency/undocumented match rate and other fiscal items once CMS supplies federal guidance.

Members signaled concern about rural hospitals and public academic hospitals that receive large supplemental payments, and repeatedly asked DMAS to provide quantification of expected budgetary impacts and to show which costs would fall to state general funds versus hospitals.

The committee will consider follow-ups from DMAS as guidance and additional fiscal analyses become available.","DMAS officials told the Joint Subcommittee for Health and Human Resources Oversight that implementing new Medicaid requirements will need CMS guidance and extra state work, and that federal limits on provider taxes and state-directed payments could cut billions from hospital payments over time.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6709495,"Reinsurance program and state exchange brace for federal changes that could shrink marketplace enrollment",3798,4265000,8063000,"/Search/View?dp=1&key=5431231-1f8ac6e8ae0378f0ad53752185ab1dc4&start=4265&end=8063","https://assets.pipeline.soar.com/5431231-1f8ac6e8ae0378f0ad53752185ab1dc4/thumbnail_4265000.jpg","/articles/6709495/Virginia/Reinsurance-program-and-state-exchange-brace-for-federal-changes-that-could-shrink-marketplace-enrollment","https://secure.pipeline.soar.com/6709495-75c44ce4c2c2a85af2325ae2504505a0/orig.mp4?Expires=1771111725&Signature=AhazXkHc32UpEZP7my77R03jcBuRRbBW6qYta~KJPpvYNF1ppxD3bXbZWC9hS3cehjHZVc~6~qZ-kieqRvNHqhgw3a8acp5W1Fqovi0ZWQylCHOWb7EPcCrJ3aWy-iB88RbgJ~-sCuLdNS3fQmKMuh4bb7XY2yMGsvd8vxhDffTw6EYkUOz1Hsr~uukgHfi9no~Oahs1cEIANLQdgtyYeTPovfa4gCwMj55rx8ATom2Dmsxz97tXBP41~5s-0gn4izip2x2xKJaqQo8Ai86rgJteFp-3ewHQnzpBw7IIZ46BpbELbwzXuSYhziHhviCfLpG-OWTz~MGJfDQp~e4Low__&Key-Pair-Id=KUT5TJCACFTXG","Brad Marsh of the Bureau of Insurance and Director Bob Padgett of the Virginia Health Benefit Exchange briefed the Joint Subcommittee for Health and Human Resources Oversight on the Commonwealth Health Reinsurance Program (CHRP) and marketplace developments.

Marsh explained CHRP is a Section 1332 state innovation waiver program that reimburses carriers for a portion of very high-cost claims to lower premiums in the individual market. The waiver is currently approved through benefit year 2027. The program uses federal pass-through funds (derived from savings to premium tax credit payments) and state general funds to reimburse carriers; unused federal pass-through funds may be carried forward.

For benefit-year design, the bureau set parameters targeting a roughly 15% premium reduction (the statute permits up to 20%). Marsh warned that the value and federal share of CHRP depend on the Advanced Premium Tax Credit (APTC) structure: if enhanced APTCs expire as currently scheduled, federal pass-through funding to CHRP would decline and Virginia's state share would likely rise. The bureau's actuarial scenarios show a range of potential state exposures depending on enrollment, the number of people receiving tax credits and changes to the risk pool.

Marsh said CHRP has contributed meaningful premium reductions so far — carriers' filings and bureau analyses show average monthly premiums roughly $98 lower per member over the first two years — and that enrollment growth in the marketplace accelerated after CHRP. But he warned that the federal calculations are prospective and payments to carriers occur after benefit years; that timing produces carryover dynamics and uncertainty. Marsh said the waiver must be renewed by Dec. 31, 2026, if the state wishes to continue CHRP beyond its current approval.

Padgett, director of the state exchange, described marketplace metrics and consumer outreach. He said Virginia's state-based marketplace helped lower uninsured rates and that, in 2025, a large share of enrollees receive substantial premium assistance: about 35% pay premiums of $10 or less after subsidies and more than 40% pay $25 or less. Padgett said the average out-of-pocket premium across enrollees is about $88 per month after federal assistance.

Padgett and Marsh both warned about federal regulatory and legislative changes. The Congressional Budget Office analysis cited during the briefing estimates that changes in federal rules could reduce marketplace enrollment by roughly 83,000 nationally in Virginia's context; Padgett noted additional modeling that suggests Virginia could see as many as 100,000 people leave the individual market if expanded APTCs expire and other federal changes take effect. He said expiration of the expanded tax credits would boost many consumers' monthly premiums by 30%–50% on average and that some households would see larger increases.

The exchange described operational steps: Easy Enroll, which uses state tax-return opt-ins to prepopulate accounts for taxpayers who want marketplace information, and support for navigators, brokers and a customer-service center. Padgett said the exchange will continue marketing and consumer-assistance investments to reduce churn and to encourage younger/healthier people to enroll, because their participation lowers premiums for all.

Marsh and Padgett said the bureau and exchange will publish actuarial and rate materials in August as part of the routine rate-review calendar, and they recommended the General Assembly consider the timing of any direction about target premium reductions or an extension application under the section 1332 waiver process.

Both officials urged the committee to weigh whether to increase the CHRP premium-reduction target (the law permits up to 20%) or to provide additional state funding for FY28 if federal pass-throughs fall when premium tax credit policy changes.","Bureau of Insurance and the Virginia Health Benefit Exchange told the subcommittee the Commonwealth Health Reinsurance Program has lowered premiums but federal changes — notably the likely expiration of expanded premium tax credits — could reduce federal pass-through funding, raise state costs and cause substantial marketplace enrollment losses.","actionData","errors"]

Article not found

Children's Services Act spending rebounds; private special-education placements remain main cost driver

Subcommittee hears DMAS plan to implement Medicaid changes and warns of large hospital payment cuts

Reinsurance program and state exchange brace for federal changes that could shrink marketplace enrollment