(The Center Square) – Virginia ranks 35th in a new 50-state Medicaid scorecard ahead of federal work requirements and more frequent eligibility reviews beginning next year.

The Heartland Institute gave Virginia 39 out of 100 points in its Medicaid Report Card, which evaluates states across 16 measures involving enrollment, spending, program integrity and the healthcare provider market.

Virginia received 17 of 24 points for program integrity and administrative oversight, its strongest category. It received 14 of 36 for program design and enrollment, 6 of 26 for fiscal sustainability and 2 of 14 for its provider environment.

The report cited Virginia’s relatively low improper-payment rate and existing all-payer claims database among its strengths. It pointed to five-year Medicaid spending growth of 8.78%, certificate-of-need laws and other provider-market measures among its weaknesses.

Under the report’s methodology, states that have not expanded Medicaid can receive 12 points for that measure. Virginia expanded Medicaid in 2019. The report also awards up to eight points for early state activity on work requirements.

Heartland notes that its scorecard does not measure every aspect of Medicaid performance. The five-year spending measure covers 2019 through 2023 and can reflect enrollment changes, provider rates, inflation and policy decisions in addition to underlying cost growth.

Virginia lawmakers have separately established a $350 million general fund Medicaid reserve for the current two-year budget. The money can be transferred to the Department of Medical Assistance Services if existing appropriations are insufficient because program costs are higher than expected.

The program is also approaching significant federal eligibility changes.

Beginning Jan. 1, 2027, certain adults ages 19 through 64 enrolled through Medicaid expansion will have to meet a federal work requirement unless they qualify for an exemption or exclusion. They can generally satisfy the requirement through at least 80 hours per month of work, education, training, volunteering or community service, or by meeting an income threshold.

Medicaid expansion recipients will also have their eligibility reviewed every six months instead of annually. About 550,000 Virginians were enrolled through Medicaid expansion as of May, although the commonwealth says the number who may need to take action will depend on exemptions and additional federal guidance.

Gov. Abigail Spanberger signed an executive order Aug. 25 directing state agencies to minimize administrative barriers and help eligible Virginians maintain coverage as the federal changes take effect. The order calls for streamlined verification, expanded outreach and use of existing government information when permitted. More than 1.8 million Virginians are enrolled in Medicaid.