Republican Attorney General Kenneth T. Cuccinelli II says he is making one red-line promise on government spending if he's elected as Virginia's next governor this year — shoring up the state's mental health system.
"I've made one spending promise, and it's mental health," he said in a recent discussion with reporters and editors from The Washington Times. "And most of that is going to be shifted within Medicaid. We have huge — and I'm talking on the order of the tens of millions of dollars — expenditures in what are called waiver programs, and we can move that money around without federal permission."
The waiver programs Mr. Cuccinelli referred to allow the provision of long-term care in home- and community-based settings but can also fund what officials describe as "nonstandard medical services," such as homemaking for patients.
"And what I'll do is move that money from what are services — but it's taking care of your house, doing these kinds of things — to try to keep people from moving into other facilities," he said. "But it is something that has drawn my attention rather clearly, and it's an opportunity to move a lot of money over to actual health care — in this case, mental health care."
To be sure, Mr. Cuccinelli is also proposing a $1.4 billion plan that slashes the personal and corporate income tax rates in the state and ties government spending to inflation — a proposal he says will create 58,000 jobs. But he has said that if the tax loopholes and exemptions to finance the plan aren't closed or cut, he won't pursue the plan.
But the commitment to mental health is one of the few areas in which the Republican candidate has called for new spending.
Currently, beneficiaries can receive services through community-based waiver programs, such as intellectual disability waivers, as an alternative to being housed in residential "training centers" in Virginia. The state is in the process of moving people housed in the centers for the intellectually disabled into community-based settings as part of a $2.4 billion settlement agreement with the U.S. Department of Justice.
Mr. Cuccinelli said about 400 inpatient beds were available in the Northern Virginia area about 20 years ago — a number that was cut in half by 2010. The Northern Virginia Training Center in Fairfax alone, which is scheduled to be closed in 2015 as part of the settlement agreement, was down to 135 beds in July, according to the Department of Behavioral Health and Developmental Services.
Health care is playing a significant role in Mr. Cuccinelli's race against Democrat Terry McAuliffe, a businessman and former chairman of the Democratic National Committee. Mr. McAuliffe supports the provision in President Obama's health care overhaul that expands Medicaid. The 2012 Supreme Court ruling that upheld the bulk of Obamacare made the expansion optional for states.
In fiscal 2012, approximately 1.1 million people in the state were covered by Medicaid, the federal-state health care program for the poor, elderly and disabled. The figure does not include those enrolled in the Family Access to Medical Insurance Security or Medicaid Expansion Programs.
The expansion could extend coverage to approximately 400,000 low-income Virginia residents. The federal government picks up 100 percent of the cost through 2017 — a subsidy that eventually drops to 90 percent.
Mr. McAuliffe has billed the expansion as a job creator in addition to the coverage aspects. But Mr. Cuccinelli, citing discussions he has had with House Budget Committee Chairman Paul Ryan, Wisconsin Republican, has said he does not believe the federal government will live up to its end of the bargain and that Mr. McAuliffe's economic extrapolations are wildly optimistic.
The rate of the program's growth in the state is comparable to elsewhere in the country, but while Virginia ranked 48th in Medicaid spending per capita in 2009 it ranked 24th in Medicaid spending per recipient.
Mr. Cuccinelli said that freeing up money will go a long way toward patching up gaps in the program.
"By shifting these dollars, we don't just help the folks in this program. Because these dollars play a significant role in what's available as a baseline for the whole community, we can impact the quality of and availability of mental health services, which are badly strained, to the extent they exist."
The attorney general said another priority for him is to audit all in-home Medicaid care — something he cannot do in his current post. Audits in states across the country have revealed widespread irregularities in how records are kept and improper and even fraudulent reimbursements.
"I have a funny feeling that if I win on Nov. 5, by late January 2014 we'll have a lot less providers in that space because they would rather leave than go through the audit," he said. "So that's my one spending item. But I'm prepared to pay for it right within Medicaid and to have the contest that will undoubtedly take place whenever you try to move dollars from one place to another."
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