VirginiaHB8382026 Regular SessionHouseWALLET

State plan for medical assistance services; adds provision related to doula care.

Sponsored By: Adele Y. McClure (Democratic)

Became Law

Summary

Department of Medical Assistance Services; state plan for medical assistance services; doula care. Adds provisions related to the provision of doula care under the state plan for medical assistance services specifying that such care includes support during labor and delivery and up to two linkage-to-care incentive payments for doulas.

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Bill Overview

Analyzed Economic Effects

16 provisions identified: 14 benefits, 1 costs, 1 mixed.

Medicaid pays for wheelchairs and genome tests

If you live in a nursing facility and need a complex manual or power wheelchair, Medicaid pays for the first purchase or a replacement. You pay no deductible, coinsurance, or copay. Medicaid also pays for rapid whole genome sequencing for children age 3 or younger in a hospital ICU. The test must give preliminary results within 7 days and final results within 15 days.

More Medicaid care for kids

The law adds more Medicaid care for children and teens. Medicaid pays for youths under 21 in foster placements or subsidized adoptions. It covers medically necessary hospital stays that last more than 21 days for people under 21. It also covers PANS/PANDAS care and infant hearing screening with needed follow‑up. Children with special needs, including victims of abuse or neglect, can get medically necessary assessments and treatment from expert providers, and families use one form to apply for FAMIS Plus or FAMIS.

Serious illness treatment and transplants

Medicaid covers serious illness treatments and transplants. For people over 21 with lymphoma, breast cancer, myeloma, or leukemia, it pays for high‑dose chemotherapy and bone marrow transplants, with expedited appeals. It pays for liver, heart, and lung transplants when strict clinical and prior‑authorization rules are met. Women under 65 screened by the CDC program who need breast or cervical cancer treatment can qualify, even without other coverage, with an expedited eligibility decision. People with severe traumatic brain injury can get targeted case management to help coordinate their care.

Surgery recovery and prostheses coverage

Medicaid covers surgery recovery and prostheses. After a medically needed mastectomy, it pays for reconstruction and for breast prostheses; medically necessary breast reduction is covered with prior authorization. It pays for at least 48 hours in the hospital after a radical or modified radical mastectomy, and 24 hours after a total or partial mastectomy with lymph node removal, unless you and your doctor choose a shorter stay. Custom ocular (eye) prostheses are also covered when needed.

Broader telehealth and remote monitoring

Medicaid pays for more telehealth and home monitoring. Coverage applies no matter where you are, and providers who deliver only telemedicine can enroll without a Virginia office if they meet federal and Medicaid rules. Remote patient monitoring is covered for high‑risk pregnant people, medically complex kids, transplant patients, people up to three months after surgery, and people with chronic or acute conditions who had two or more hospital or ER visits in the past year. If EMS helps set up a live telehealth visit, Medicaid pays the agency an originating‑site fee. Provider‑to‑provider consults are paid on terms at least as good as fee‑for‑service, and schools can be paid for qualifying services for Medicaid‑eligible students, even without an IEP.

Long-term care insurance partnership program

Virginia can run a long-term care partnership program that works with qualified private long‑term care insurance. The program follows federal rules on how Medicaid treats your assets and estate if you buy a qualified policy.

Medicaid asset and income protections

The law protects some assets when Medicaid checks eligibility. It ignores up to $3,500 set aside for burial for you and $3,500 for your spouse, reduced by life‑insurance face value and any burial trusts. For many applicants, the home is not counted if extra contiguous land (besides the house lot) is worth $5,000 or less; if older 1972 rules require a stricter definition, that older rule applies. If one spouse is in a facility and the other lives at home, some of the patient's income is set aside to support the spouse.

More Medicaid help around childbirth

The law expands Medicaid help around pregnancy and birth. Recently lawful residents who are pregnant and otherwise eligible get coverage. Medicaid pays for postpartum hospital care and home visits, plus at least four dental visits in pregnancy and up to 10 doula visits (4 before, 6 after within 12 months). Family planning starts at delivery and lasts 24 months if you still meet the pregnant‑woman income rules; you may receive up to a 12‑month supply of hormonal birth control at one time. Medicaid also pays for at‑home remote ultrasounds and fetal non‑stress tests when FDA‑approved devices are used and billed for at‑home monitoring.

Provider payments, enrollment, and appeals

The law improves payments and rights for Medicaid providers. The Department must contract with licensed mental‑health clinicians who apply for the services they are licensed to give, and pharmacies get paid for services under collaborative agreements or as allowed by law. Payments use electronic funds transfer when practical. Durable‑medical‑equipment paperwork must be signed and in the supplier’s files within 60 days of first delivery. If a Medicaid provider contract is denied or ended under the listed rule, the provider can appeal in writing within 15 days and get a hearing.

Faster Medicaid contracts for special-needs care

DMAS can negotiate special service agreements for people with special needs, like people with AIDS or who need ventilators. The Board writes rules defining these groups. These contracts can bypass parts of the state procurement act, but must follow federal law.

Keeps Medicaid aligned with federal rules

DMAS can run the Medicaid plan, take federal funds, and sign contracts needed to operate it. With the Governor’s approval, the Board updates the plan quickly to match federal law so Virginia keeps federal reimbursements. The Board works with the State Board of Health to protect patient rights and quality, and it must check and share local fiscal impacts before filing certain rules.

Adult children may help pay parents' Medicaid

The Board seeks federal approval to set up a family assistance program. Once established, adult children age 18 or older may have to make reasonable payments toward a parent's Medicaid-covered care. The Board sets amounts and procedures in regulations, and the program must follow federal law.

Cancer screenings covered by Medicaid

Medicaid covers key cancer screenings. You get a yearly Pap smear. Mammograms: one at ages 35–39, every two years at 40–49, and yearly at 50+. Prostate screening covers one PSA test and a digital rectal exam every 12 months for age 50+, and for age 40+ at high risk. Colorectal screening follows the newest gastroenterology and cancer‑society guidelines for test type and timing.

Medicaid choice for infants in early intervention

Children from birth through age 3 who are certified for early intervention under Part C can get an exception to mandatory Medallion II managed care enrollment. The Department updates its waiver and rules to set how this exception works.

Member cards and application help

Agencies that take Medicaid applications must collect good contact information and give each applicant clear information about advance directives and how to make one. Each Medicaid member gets a prescription or benefit card, and the state reissues or corrects it when required data change.

Stricter Medicaid rules for problem providers

If a Medicaid provider is convicted of a felony, the contract ends. The Director can also refuse, end, or suspend contracts for principals of companies convicted of listed crimes or excluded from federal programs, and for home care organizations under state-law grounds. Providers can seek reinstatement if a conviction is reversed.

Sponsors & Cosponsors

Sponsor

Adele Y. McClure
Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 265 • No: 0

Senate vote • 3/10/2026

Passed Senate Block Vote

Yes: 40 • No: 0

Senate vote • 3/9/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote • 3/9/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 40 • No: 0

Senate vote • 3/6/2026

Reported from Finance and Appropriations

Yes: 14 • No: 0

Senate vote • 2/26/2026

Reported from Education and Health and rereferred to Finance and Appropriations

Yes: 15 • No: 0

House vote • 2/17/2026

Read third time and passed House Block Vote

Yes: 97 • No: 0

House vote • 2/11/2026

Reported from Appropriations

Yes: 22 • No: 0

House vote • 2/11/2026

Subcommittee recommends reporting

Yes: 7 • No: 0 • Other: 1

House vote • 2/10/2026

Reported from Health and Human Services and referred to Appropriations