By John Tuason, Politics and Government reporter
With federal cuts looming and open enrollment only a few weeks out, Deepak Madala is helping to prepare Virginians for another season of healthcare uncertainty.
Madala started working at the Virginia Poverty Law Center (VPLC) twelve years ago, when the Affordable Care Act was first implemented in Virginia. He and his boss, Jill Hanken, created a program called Enroll Virginia. Enroll Virginia is a community-based effort to educate Virginians about health coverage options and provide enrollment assistance. The program was recognized by the US Department of Health and Human Services to participate in the Federal Navigator program.
In an interview on Thursday, Deepak discussed the work being done at the VPLC, how the upcoming Medicaid cuts will affect Virginians, and the unique challenges that immigrant families face regarding healthcare.
His comments were edited slightly for length and clarity.
What are the biggest challenges facing the VPLC?
Health insurance is complicated. You know, I think that’s the main challenge. While we’ve expanded, and established a good team statewide, it’s still not enough.
The people we work with; their situations are all highly specific to them and their family. It’s dependent on their personal medical needs, their personal financial situations, and their resources. That complexity has always been our biggest challenge.
There are a lot of changes coming to both the Virginia marketplace and the Medicaid program in the coming years. We’re trying our best to kind of stay ahead of that, to keep our team trained and understanding what those changes are. We’re assisting people as they’re navigating the healthcare system by both kind of helping them through those changes, but also anticipating what’s coming down the road, and helping prepare them for those.
What are the challenges that are coming up for Virginians?
It’s something that always happens, but what’s around the corner right now is that when people enroll in coverage through that marketplace, that coverage is only for one year, so they have to renew that coverage every single year and they do that during what’s called open enrollment. Open enrollment in the marketplace starts in November first, and then it goes through end of January here in Virginia.That’s a relatively short amount of time, so people need to actively go to their accounts, check and see what the prices are and see if there are plans that are and what their budget can afford.
During the COVID pandemic, the federal government expanded and the subsidies that were available to help make some of those private insurance plans more affordable. There’s still help like that available for 2026. But they’ll be less of them available because of cuts being made at the federal level to these programs.
One of those cuts was to enhanced subsidies. So, when people go to shop this fall, starting in November, they may see higher prices. Thankfully, in Virginia we still actually have a very competitive insurance market. We have a lot of different companies that do serve statewide.
How will Medicaid cuts at the federal level be affecting Virginians?
Because of this loss of subsidies and other changes that are in the news right now like Medicaid work requirements, paperwork requirements, and renewals for Medicaid. A lot of that stuff is more likely to come into play in 2026. Administrative types of burdens are going to being placed on people, and in some other states that have already gone through work requirement implementations. In states like Arkansas and Georgia that have implemented work requirements, the biggest problem was the absurdity of how they wanted people to submit their documents.
In Arkansas, for example, the website that they had to submit their documents to was only open during business hours during the week. If you’re a working person, you may have multiple jobs. So, when the website’s not even open, you’re losing your Medicaid coverage because you can’t submit the documents on your schedule. I’m hopeful that Virginia will have more reasonable expectations.
What is different about working with immigrants?
There are many areas in Virginia where there are large numbers of immigrants who don’t have access to insurance through jobs, or through universities for some reason; yet, most Virginian immigrants, do have legal status of some type. It just depends on their situation. Perhaps they’re self-employed. If they run their own business, they themselves don’t have access to insurance because of that. So that’s when we help them through the marketplace because they are not eligible for Medicaid.
Some of the of the broader challenges we see facing immigrants nationwide are families who have U.S. Citizen children who are eligible for a lot of benefits because they’re a U.S. Citizen child. There’s always concern from those families about how their data is being used and whether that is private or not.
So, there are parents who do not meet Medicaid requirements, but their children do?
Exactly. This is one of the misunderstandings people have a lot, particularly in regard Medicaid in Virginia. You do have to be what’s called a qualified immigrant to access benefits, and in most cases, that does require you to have a green card, and to have had that green card for 5 years.
A big hurdle to get over is that you must be a legal permanent resident and have had that legal permanent residence for up to 5 years before you can benefit from the Medicaid program. So, that means a lot of Virginia immigrants don’t qualify.
This 5-year bar is why private insurance is so important, because they can go and purchase plans through the marketplace. Some may even qualify for those nominal tax credits to help pay for some of the premiums, but at the end of the day they’re still paying for insurance.
Because they’re not eligible for Medicaid does not mean their children are not eligible for Medicaid, however. This is where it gets complicated. The vast majority of Americans just sign up through work, and there you go, you’re all covered. It’s more complicated for people who don’t have that, because you may have to sign up for 3 or 4 different programs because every person in the household is in a different program.
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