Senate subcommittee reviews $857M general‑fund increase proposal; Medicaid growth, behavioral health and DD waiver costs lead

Subcommittee staff briefed members on the governor’s introduced amendments to the Health and Human Resources portion of the biennial budget, highlighting a large Medicaid forecast adjustment, behavioral health investments and multiple member‑sponsored amendments.

Staff said the introduced budget adds roughly $857 million in general‑fund and $2.3 billion in nongeneral fund spending over the biennium, with the largest single increase driven by Medicaid growth (about $632 million in the forecast). The Children’s Services Act forecast was the next largest item cited, at roughly $105 million.

Behavioral health and developmental disability funding accounted for several significant line items. Staff described a $35.2 million proposal to fund special conservators of the peace in some private hospitals; the role would be to relieve law enforcement of custody responsibilities for individuals awaiting emergency custody orders (ECOs) or temporary detention orders (TDOs). Staff said those special conservators would receive de‑escalation training and be intended to use least‑restrictive measures.

Additional DBHDS and DMAS items included funding for implementation of a seriously mentally ill waiver (about $1.2 billion over the biennium tied to waiver slot growth and administrative costs), $4.6 million directed to administration and quality assurance connected to compliance under a recent permanent injunction, and administrative funding for DD waiver slots and service authorizations. Staff reported a permanent injunction requiring compliance activities over seven years and tied some funding to meeting the court’s requirements.

Staff noted proposals to expand psychiatric and OBGYN residency payments, change adult day health reimbursement from a daily to an hourly rate, and to fund long‑acting injectable medications that can be administered before discharge from emergency settings to bridge individuals to community care.

The meeting also discussed legacy state facilities. Staff said Hiram Davis currently houses roughly 37 residents and that renovation plans to move some patients to Southeast Virginia Training Center would likely cost tens of millions of dollars; an initial renovation estimate cited in the discussion was over $50 million.

Members reviewed a long list of member budget amendments across agencies. Examples include: - Department of Health: two‑site perinatal hub pilot; funding for community health workers and doulas; funds to catch up on backlog for home care organization licensure; support for local health department rent increases and an electronic health record initiative. - Department of Social Services: increased pass‑throughs to local agencies, more funding for kinship care and interstate kinship MOUs, child advocacy centers, conversion of EBT cards to chip cards to deter fraud, SNAP increases for elderly recipients and a peer support helpline for DSS staff. - Disability services and DARS: administrative funding to reflect back‑office costs and program consolidations, plus specific program supports for blind and vision impaired services and a study of digital transition at Virginia Relay.

Committee staff and members discussed the potential federal risk of changes to Medicaid match rates, noting that a large federal policy change could require a special session or other rapid response; one staff presenter estimated that an immediate change to the state match could cost Virginia well over $2.5 billion in the current year if the federal match reverted to a normal state rate.

No final budget votes were taken by the subcommittee during the meeting; staff said member amendments will be tracked and revisited as the subcommittee works the budget.