State social services workers signed up homeless residents for Medicaid at a resource fair in Richmond in early November. (Ned Oliver/ Virginia Mercury)

The Virginia Mercury launched in July to provide a sustained focus on statewide issues that have fallen through the cracks as traditional news outlets shrink. Here’s the second in a holiday-week series looking back on how we’ve spent our time since then.

For years, one of the most vehemently debated topics in Virginia has been Medicaid expansion. But the arguments were (mostly) put to rest earlier this year when the state became the 33rd in the country to expand.

It was a big move for Virginia, which formerly had some of the least generous eligibility rules in the country. Before expansion, childless adults weren’t eligible for coverage at all, and parents could only make $6,900 a year, or 33 percent of the federal poverty level. Disabled adults couldn’t make more than 80 percent of the federal poverty level, equaling about $9,700 a year.

Under expansion, eligibility rules jump up to 138 percent of the federal poverty level, or $16,754 for an individual and $28,677 for a family of three.

Enrollment took off after Nov. 1, when the newly eligible population was able to sign up, drawing more applicants than the state expected.

The state had hired 310 additional eligibility workers to add to local departments of social services. By late December  more than 182,000 people had successfully enrolled, and the state expects that number to steadily increase over 2019.

Advocates have high hopes for expansion and what it could do for Virginia, like improving the rate of uninsured kids, providing much-needed health care for those with mental illness and substance use disorder and increasing access to housing services.

Lisa Coles fixes Pam Atkinson’s necklace. The two work at Goochland Cares’ clothes closet and will qualify for Medicaid once Virginia expands its program on Jan. 1. (Katie O’Connor/ Virginia Mercury)

Some bickering persists, though, largely around the work requirements that were necessary to make expansion more palatable to Republicans. It could take years for the federal government to approve the waiver that Virginia needs to implement the requirements, and Republicans have shown frustration with that timeline.

“If it comes a year later, in 2021, you’ve got to be kidding me,” Sen. Ryan McDougle, R-Hanover, said during a Senate Finance Committee meeting.

The work requirements come with a slew of exemptions, and Republicans postponed sending the waiver to the federal government in November over concerns about them. They weren’t the only ones concerned — the state received more than 1,800 comments about the work requirements from the public.  However, only four expressed some kind of support.

Exactly what expansion will do for Virginia can only be told with time, of course, as the state continues to watch the number of providers to ensure there are enough to cover the new population.

There is also a significant federal court decision that remains to play out fully that could impact the program.

While most health policy experts agree expansion will improve the lives of the nearly 400,000 newly-eligible Virginians, there are still gaps in health coverage. About 323,000 people will remain uninsured in the state and continue to rely on free clinics and emergency rooms for care, and dental benefits aren’t covered under Medicaid at all.