Mike Thompson over at the Thomas Jefferson Institute has some questions about Medicaid expansion. More specifically, he has a list of ten questions that he thinks should be further discussed as part of the ongoing debate that’s created a stalemate in Richmond. I won’t pretend to be qualified to give an expert answer to all of them – but there were two that I think some data might be able to shed some light.

They have to do with how many doctors accept Medicaid patients altogether. As Thompson asks:

If fewer doctors are taking Medicaid patients because the government’s reimbursement rates don’t cover the actual costs, how will expanding the Medicaid population do anything other than make this financial nightmare even worse?

Of course, the answer to this question not only depends on whether Medicaid gets expanded, but how the General Assembly (and Governor McAuliffe) decides to expand the program. There are currently two systems that the state government could decide to use for Medicaid expansion.

The first system is called fee-for-service, which is how disabled seniors receive care. Under fee-for-service, it’s as simple as a patient visiting a doctor and then paying at the office after the visit. This is how the majority of patients (in the nation) receive their medical care. There’s a reason why 30 percent of Virginia’s Medicaid population (the disabled seniors) consume over 70 percent of the overall Medicaid expenditures. FFS creates a perverse incentive for doctors, who are paid for the amount of care they provide patients rather than the quality of care.

As of 2013, about two thirds of Virginia’s current Medicaid patients receive treatment from a Managed Care Organization, which is designed to better coordinate medical treatment. The idea behind the MCO is that too many people are receiving non-emergency treatment in emergency rooms – burning up expensive medical services. When you receive your Medicaid treatment from a MCO, you’re care is better coordinated so that you receive preventative treatment, or other less costly treatments.


Graph provided by Virginia DMAS

A recent study by the Joint Legislative Audit & Review Commission explains how the MCO model might increase payments to providers and improve outcomes:

With regard to provider payments, there are several notable differences between the fee-for-service and managed care systems. Whereas [the Department of Medicaid Services] pays similar providers the same rate for a particular service, MCOs often negotiate rates with providers. When necessary to obtain services for Medicaid enrollees in their network, MCOs may pay rates that are significantly higher than the fee-for-service rate. Moreover, four of the six MCOs pay primary care providers an administrative or management fee of $1 to $2 per patient in addition to the base reimbursement rate, and MCOs sometimes make incentive payment to providers that achieve certain performance goals.

So while covering costs is an important piece of the Medicaid expansion conversation – it masks the real relationship between Medicaid payments and the cost of providing care. Under an MCO system, payments could be tied to reducing costs, benefiting providers, taxpayers and patients.


Transcript of Q&A with county executive on proposed budget plan

On February 28, Fairfax County Executive Edward Long answered online questions regarding the proposed budget plan for the 2014 fiscal year. In total, 19 questions were asked. An excerpt of the Q&A is posted below. To read the full transcript, click here.

Tysons Engineer : Executive Long, What effect will the transportation bill have for 2014 transportation expenditures, and has this been incorporated in your analysis?

Edward Long : The transportation bill recently passed by the General Assembly and awaiting signature by the Governor would have a positive impact on funds available to address transportation projects in Fairfax County and Northern Virginia. Our budget was put together prior to this proposal by the state. Over the next few weeks, staff will review the details and make budget adjustments, if necessary.


Anonymous User : When you spoke with county residents, which services did they seem most and least concerned about cutting?

Edward Long : The common theme has been to protect those most vulnerable in our community and to preserve the high quality of life associated with Fairfax County, including our outstanding school system. In addition to having community engagement sessions and the opportunity to give online input, I also solicited direct feedback from community organizations, such as the Chamber of Commerce. These groups affirmed the need to maintain the county’s strengths, and not take a budget axe to our core programs.


Anonymous User : With property values continuing to rise, why is it necessary to increase property tax rates? I am unequivocally opposed to such an increase.

Edward Long : As I mentioned in the budget, I feel that an investment is necessary to maintain the county’s strengths while we go through this difficult period in anticipation of the opportunities that will present themselves in FY 2016 and FY 2017. The bulk of this $.02 increase is necessary to fund the increase in our growing student population.

I’ve also included over $20 million worth of cuts in the budget, eliminated 91 positions, and will not be providing any pay raises to county employees.

I think this $.02 investment is necessary to prudently carry the county through FY 2014 and FY 2015.

NVCC officials, nearby residents meet to discuss parking concerns

NVCC officials and nearby residents of the Annandale campus met to discuss parking and traffic issues along Wakefield Chapel Road.

NVCC officials and nearby residents of the Annandale campus met to discuss parking and traffic issues along Wakefield Chapel Road.

At a February 25 community forum, nearby residents of the NVCC Annandale campus met with college officials to discuss parking and traffic concerns along Wakefield Chapel Road.

The forum, hosted by Supervisor John Cook (R-Braddock), brought out about 30 residents to Wakefield Forrest Elementary School.

“I understand parking of our students on the streets is an issue,” said Barbara Saperstone, provost of the Annandale campus. “We are listening. We are addressing some of those concerns as best we can. We are trying to get them back into the parking lot as best we can.”

Attendees raised both parking and traffic concerns along Wakefield Chapel Road, adjacent to the NOVA campus.

One forum attendee said that the street’s bike lanes, which were put in August 2010, have exacerbated the problem of students parking along the road, instead of parking on-campus.

“I really think you people have missed a lot of what’s going on,” said the resident. “The bike lanes provide a free space for students to park along Wakefield Chapel.”

“Prior to the bike lanes, there was always free available parking along Wakefield Chapel,” Cook said in response. “By narrowing the driving area, that speeds tend to come down.”

Several attendees urged the college to remove parking fees for on-campus parking to reduce incentive to park on Wakefield Chapel Road.

“When we get to the big solution to this problem,” said one attendee, “folks should know that if all the students parked in the lots like they should be able to do, all these problems…wouldn’t exist.”

Other attendees asked if parking costs could be paid for through other funds, or if parking revenue made up a significant amount of the NVCC budget.

“We cannot use the tuition money to pay for parking,” said Saperstone. “It has to be self-sufficient. My understanding is [the parking fees] have to be used for parking.”

In a letter to the college’s administration, presidents of five nearby neighborhood associations urged the administration to take action on the issue.

“In recent years, neighborhoods close to campus have responded to student parking and traffic by setting up residential parking districts,” read the letter. “In our view, this unfairly shifts the burden created by your parking policies to the tax paying residents of Fairfax County. In addition, those RPDs just shifted the problem to other streets, in particular Wakefield Chapel Rd, and has made the safety and traffic problems much worse.”

Janyce Hedetniemi, who was recently appointed as an at-large member of the Fairfax County Planning Commission, signed the letter as president of the Oak Hill Citizen’s Association.

Saperstone said that NVCC was aware of the problem and has been exploring ways to address parking and traffic, including an online carpooling program, increased shuttle service, and stagnated school schedules.

“I’m here to say that I am listening,” Saperstone said.

Fairfax city council discusses future of downtown with Mason student government

New story on Connect2Mason:

Representatives from George Mason University Student Government met with the full Fairfax City Council to discuss the relationship between the city and the university.

The special session, held on Feb. 19 in Mason Hall, focused on encouraging more students to spend time in Old Town Fairfax, located less than a mile north of the Fairfax campus.

“We know that you have great interest in our downtown and some of the development and redevelopment issues that have been ongoing,” said Scott Silverthorne, mayor of the City of Fairfax. “Frankly, we thought it would be helpful tonight to have a broad discussion about what you all see as important for our downtown.”

The council and three members from Mason Student Government discussed different ways to attract more students downtown.

Read the rest here.

Bill removing income tax referendum passes senate

A proposed bill would allow Fairfax County and the City of Fairfax to levy an income tax without a referendum.

A proposed bill would allow Fairfax County and the City of Fairfax to levy an income tax without a referendum.

A bill in the Virginia General Assembly that removes the requirement that localities hold a referendum to enact an income tax has passed the senate.

Senate Bill 1313 would amend § 58.1-540 of the Virginia Code that allows a select number of localities to pass an income tax for transportation purposes. The City of Fairfax, Fairfax County and several other Northern Virginia localities are permitted to levy the tax. Currently, state law requires localities to hold a referendum on the issue. Under the new law, a tax could be levied by a majority vote by either the city council or the board of supervisors.

On Feb. 5, the bill passed the senate with 27 votes in support and 11 against.

“This is a mistake,” Senator Chap Peterson (D-37) wrote in a Feb. 5 blog post. “While income tax can raise a lot of revenue, it also is a tax that is EXCLUSIVELY paid by Virginia tax filers.  It is not paid by out-of-state users of our highway, who are 30% of our highway traffic.  It is not paid by Virginia residents who file out-of-state returns.  It is not paid by ‘cash only’ businesses.”

“If agreed by the House, this bill would place a surcharge on northern Virginians, by requiring them to pay an extra tax for the same state service enjoyed by others for free,” Peterson said.

The bill was first introduced in the senate by Walter Stosch, a Republican representing Henrico County.

Advocates push for adoption of Tysons bicycle plan

Phase 1 of the Fairfax Bicycle Master Plan is expected to come before the planning commission early in 2013.

Phase 1 of the Fairfax Bicycle Master Plan is expected to come before the planning commission early in 2013.

Bicycle advocates are pushing for the adoption of a master plan for cycling in the Tysons Corner area. The plan makes several recommendations for encouraging bicycling as a viable alternative form of transportation in the area.

“The Master Plan will be a roadmap for creating better conditions for bicyclists in Fairfax County over the next 10-15 years,” Bruce Wright, chairman of the Fairfax Advocates for Better Bicycling, said in an email.

The plan, which was sponsored by Fairfax County, splits its recommendations into five different categories that focus on both infrastructure improvements and ways to encourage new riders.

“Children and adults need to learn how to ride safely through bicycle safety classes in school and other venues, and police need to enforce traffic laws to reduce speeding and dangerous behavior by motorists and bicyclists,” Wright said. “We also need better knowledge of how many people currently ride and whether that number is changing over time, and there need to be concrete goals that are evaluated on a regular basis.”

The plan is meant to provide a roadmap for how best to improve bicycling prior to the opening of the Silver Line Metro stations in December of this year.

“Both Supervisors Hudgins and Smyth recommended that a bike plan be created for Tysons before trying to plan the entire county,” said Wright.

Proposed infrastructure projects include paths directly to Silver Line stations, and available bike facilities, as well as improvements to existing roads.

“I think the most difficult part of the plan was how to fix major roads, often referred to as major arterials, such as Routes 1, 7, 28, 50, and 123,” said Wright. “There are various possible treatments depending on how the adjacent areas develop in the future. Some advisory committee members wanted more specific recommendations for these roads. They are a major challenge in creating a safe, connected bicycle network.”

In 2006, the county created an initiative to incorporate bicycling into many of its planning objectives and studies.

“The initiative included creation of the bicycle program, including hiring of the bicycle coordinator, production of the bicycle route map, and development of some on-road bike routes,” said Wright. “From looking at the route map it’s clear there are several areas where there were no safe ways to connect safe bike routes. Creating a connected bicycle network is one of the goals of the plan, which would help close those gaps.”

“County staff who developed the plan have been worked long hours and attended many meetings in helping to create the plan,” Wright said. “The plan is in draft form so there has not been much feedback from elected officials yet. There have been two presentations to the Planning Commission and feedback was mostly positive.”

The master plan must be approved by the county planning commission and board of supervisors before it is fully incorporated as county policy.

“FABB is hopeful that the plan will be approved by the Planning Commission early this spring and by the Board of  Supervisors this summer,” said Wright.


Both the Tysons Corner plan and the countywide bicycle plan will go before the county planning commission and board of supervisors later this year.

Fairfax County and city receive high marks on budget availability

A recent study by the Virginia Coalition for Open Government reported that the City of Fairfax and Fairfax County provide easy online access to their respective budgets. (Photo courtesy of the Virginia Coalition for Open Government.)

A recent study by the Virginia Coalition for Open Government reported that the City of Fairfax and Fairfax County provide easy online access to their respective budgets. (Photo courtesy of the Virginia Coalition for Open Government.)

In a recent report, both the City of Fairfax and Fairfax County received high marks for providing easy online access to their respective budgets. The study was conducted by the Virginia Coalition for Open Government, a non-profit that advocates for expanded access to government information on the state and local level.

The City of Fairfax was the only locality to receive an “A+”, the highest ranking possible.

“It took only one click to get to the budget, the word “budget” was used, the budget was available in its entirety, was searchable by keyword, provided context and explanation and was available in the first page of search-box results,” read the report. “There were also five years’ worth of past budgets available. Finally, the city’s site included multiple formats for the budget.”

In a release posted on the city’s website, David Hodkins, assistant city manager and finance director, said “the city is immensely pleased with the resultes of this study.”

“We want people to easily find and use the city’s budget on the city’s website,” said Hodkins. “What we write on the website remains true: the city’s budget is the blueprint for financial and policy decisions implemented by the city. It truly is the single most important document we can give the public.” (Emphasis by City of Fairfax.)

Fairfax County received an “A.”

The report said that some might have assumed the largest and wealthiest localities had the best access to their respective budgets, but that was not the case. None of the cities who received an A or A- were among the state’s largest, and only two of the state’s largest counties received high scores. The report, however, concludes that the largest localities “are in some way victims of their own success.”

“Their websites are typically full of information and often feature slick interfaces,” read the report. “They may thus present their residents with loads of information, but that information may be hard to sort through and navigate.”

In a letter by Meghan Rhyne, executive director of the organization, she explains how VCOG rated each locality.

“We examined whether the budget was available in one comparative document, in sections or both,” read the letter. “We looked at formats and whether it was searchable by keyword. We looked at whether the budget could be found on a home-page search box or a site map.”

Apart from measuring budget availability, the report also examined whether the budget documents were easy to understand or if past budgets were also accesible.

“We wondered if past budgets were available and how many,” read the report. “We searched for context, explanations and summaries. And we took note of helpful information along the way: explanations of the budget process, a budget calendar, citizen input, offers of free budget CDs.”

Across the commonwealth, the average number of clicks it took to reach the budget was three, including both counties and cities. The websites for fifteen localities did not contain any budget information at all.

The report says that without the budget,”there’s nothing else,” and that focusing on budget availability is the “most literal way that government can be held accountable.”

Additional resources: