Virginia Medicaid director details 18 budget items, rapid SMI waiver push and managed‑care concerns

Cheryl Roberts, Medicaid director at the Virginia Department of Medical Assistance Services, told the Health and Human Resources Appropriation Subcommittee that the agency’s current appropriation is about $24,000,000,000 and that the agency is planning 18 items in the governor’s budget to address staffing, program changes and federal rule changes.

Roberts said the agency has reached “99% at the unwinding,” and that the department’s financing and program changes are being driven by federal oversight from the Centers for Medicare & Medicaid Services and the governor’s office as well as the General Assembly. “For everything that we do, we have accountability, obviously, to the governor, to you, and to CMS,” she said.

Why it matters: The presentation laid out funding and operational requests that would reshape Medicaid administration and provider payments for the coming biennium, while flagging implementation deadlines required by federal rules and an ongoing major procurement that the department says it must begin to implement despite pending litigation.

Key budget and program highlights

- Overall spending and funding split: Roberts said the agency’s appropriation is “at 24,000,000,000 and counting,” funded roughly 51% with federal funds and 49% with general funds as of Jan. 1. She emphasized the role of the Medicaid expansion in covering more adults and the program’s continued large role in children’s coverage.

- SMI waiver and crisis beds: Roberts described a state request for a serious mental illness (SMI) Medicaid waiver designed to allow larger crisis facilities to be reimbursed. She said the waiver application was…