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JLARC staff recommends study of DMAS oversight of managed‑care organizations
Summary
JLARC staff proposed a focused review of the Department of Medical Assistance Services’ oversight of managed‑care organizations (MCOs), including forecasting approaches and a review of the new capitated nursing‑home rate; members signaled support and asked staff to draft study language.
Justin Brown, JLARC senior associate director, proposed a targeted JLARC study of the Department of Medical Assistance Services (DMAS) focused on the agency’s oversight and performance management of managed‑care organizations and related forecasting practices.
Brown told the subcommittee that managed care is a “critical component” of the system and suggested the review could include DMAS’s MCO management, the recently implemented capitated nursing‑home rate, and the department’s forecasting approach. Brown noted the general‑fund component of Medicaid is substantial and said the topic could be fleshed into a draft study resolution for member review.
Senator Evan raised whether state systems will be prepared for pending federal changes affecting eligibility redeterminations and said it is important to know whether state agencies (or the Department of Planning and Budget) are already reviewing system readiness. Brown acknowledged the technical and evolving nature of that question and said staff would consider member interest in how forecasting and system readiness are handled.
Members flagged concerns about Virginia’s cash‑basis budget volatility and past forecasting weaknesses and asked staff to consider whether independent legislative oversight of forecasting accuracy is warranted. The subcommittee signaled this is one of the top candidate studies and asked staff to draft scope language and return with a recommended priority ranking.
Next steps: staff will draft a study resolution and scope for DMAS MCO oversight, estimate level of effort, and present a ranking recommendation to the subcommittee and then the full commission.
