Everardo Cuevas-Espinoz

Free Clinic of Danville nurse practioner Everardo Cuevas-Espinoza flips through a clipboard of medical forms near closing on Tuesdsay. With Virginia’s Medicaid expansion underway, the free clinic is helping their clientele apply for Medicaid while evaluating how it will fill any new pocket of need that may form.

Since enrollment under Virginia’s new Medicaid requirements opened in November, local social services departments have seen hundreds more clients enrolled in the program.

The Pittsylvania County Department of Social Services saw the number of enrollees increase by 763 between November and December, hitting 13,766. The county’s total population is 61,258.

“We think that trend will continue, how far into the future that trend will continue before it plateaus or smooths out, we’re not sure,” said Chris Spain, the director of the county’s social services agency.



Spain and benefit programs supervisor Sue Palmer said the state projected that the agency should expect to receive at least 3,200 new applicants — who may or may not be deemed eligible.

“It could grow, as the word gets out even more,” said Palmer.

In Danville’s social services department, benefits program manager Faye Brown said the department had seen “a steady increase” since October, with the number of enrollees increasing by more than 150 per month. As of December, 9,103 — nearly a quarter of Danville’s population — was enrolled in Medicaid.

“We have to remember, too, that we’re talking about individuals that have to be at or just above the poverty limit,” said Brown. “And we have a lot of people that’s living at the poverty level.”

According to report conducted by United Way in 2017, 19 percent of combined Pittsylvania and Danville households meet or fall below the federal poverty level.

When Virginia voted to approve the Medicaid expansion after a push by Gov. Ralph Northam and a newly blue House of Delegates, the change meant the state would finally adopt the eligibility requirements for Medicaid set forward under the Affordable Care Act.

The majority of funds to pay for Medicaid insurance costs — 90 percent — are covered by the federal government; the other 10 percent comes from a state tax levied on hospitals.

Before the expansion, no single individual between the age of 19 to 64 was eligible unless the person was disabled with an income at or below $9,700 per year. Families’ income requirements were almost negligible, requiring a family of three to make at or below $6,900 annually.

Under the new requirements, a single adult or a single disabled adult may be eligible with an annual income at or below $16,754. Families follow the same income guideline, if they make 138 percent of the federal poverty level or less for their size then they may qualify.

Rather than $6,900 per year, a family of three now has to make at or below $28,677 to be eligible.

As of Jan. 1, those who applied and qualified under the expansion’s terms are now covered and can go to providers that accept Medicaid, like Piedmont Access to Health Care.

PATHS is a nonprofit health care provider serving the Dan River Region with community medical centers in Chatham, Danville, Martinsville, Boydton and South Boston.

Piedmont Access to Health Care Executive Director Kay Crane said, “When they say they expanded Medicaid what they meant was they changed the eligibility requirements to meet the needs of more people.”

Crane said around 23 percent of PATHS’ clientele is uninsured, and they’re hopeful that most of them will qualify under the new eligibility requirements. The nonprofit has sent outreach workers throughout the community to help people sign up, attended public events and worked on the application with people at the centers.

“At all of our service areas, we’ve always seen large numbers of uninsured,” said Crane. “This will really go a long way in diminishing the number of uninsured.”

Throughout the ongoing enrollment period, prospective applicants have been able to submit online, over the phone with the Cover Virginia call center or in person at social services agencies.

Brown said social services clients who were already receiving benefits like SNAP — the supplemental nutrition assistance program, formerly known as food stamps — were automatically sent a streamlined application as the departments already had some of the necessary information.

Both Brown and Palmer said processing the increased applications have gone smoothly without putting too much extra strain on the agencies. That outposts and online enrollment have eased the burden of reviewing the initial paper applications, and the departments were provided funds to hire more staff to spread the growing caseload.

Palmer and Spain noted that some clients who were already being serviced by the state’s limited insurance programs like the mental healthcare-centered Governor’s Access Plan or PLAN First for family planning services will now have better coverage with less gaps.

For those who still don’t qualify for insurance or still can’t afford the premiums under Medicaid, safety nets like the Free Clinic of Danville will still exist.

“Even with the Affordable Care Act and Medicaid expansion, there will always be a new pocket of folks who can’t afford the health insurance or the premium,” said Free Clinic of Danville Director Denise Buckner.

Buckner said the clinic expects that a large chunk of their patient-base will now be eligible under the new requirements and have begun assisting them with the application process.

“We started calling our patients as soon as the legislation passed,” she said. “Any time people can get insurance that’s a positive thing.”

Once enrolled, the clinic volunteers are also helping their patients find new providers while managing the medical needs in the transition.

As the patients transition, the clinic is also in a state of limbo — waiting to see if they’ll need to broaden their own income parameters to accept a new set of people.

Right now, their threshold is set to help people whose annual income is at or below 200 percent of the federal poverty level, more lenient than the eligibility requirement for Medicaid. For example, a family of three could make $46,960.

At this point, local officials are optimistic that more people in need will be served, receiving the medical treatment they need.

“I think the greatest thing is the fact that there’s so many people out here that haven’t been able to afford it and they’ve been without medical coverage and medical assistance because they couldn’t afford to go to a doctor,” said Palmer. “We want to get them on there as fast as we can.”

As the economy improves in the region and people age out of Medicaid into the realm of Medicare, Brown imagines that the number of enrollees could start a gradual decline.

But, until then, “it just means that more people are insured,” she said. “Hopefully, they will take advantage and use it for their health issues to get help.”

Halle Parker reports for the Danville Register & Bee. Contact her at hparker@registerbee.com or (434) 791-7981.

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