Virginia is one of only six states that require legal, non-US citizens to provide 10 years of work history before they’re eligible for Medicaid. It’s called the “40-quarter” rule because the 10 years are broken down into 40 required quarters of work. Spouses and parents of minors can transfer work quarters.
It’s a remnant of President Clinton’s 1996 ‘Welfare to Work’ legislation still on the books of states like Virginia. Current federal law requires only five years of residence for lawful permanent residents, but there's no federal requirement for work history.
“If you’re a single adult that migrates to this country, you may have to wait up until 10 years until you’re eligible for Medicaid here in Virginia,” said Freddy Mejia, healthcare policy analyst with the Commonwealth Institute for Fiscal Analysis. “This is something that not a lot of people know about, but unfortunately many people are suffering the consequences of this rule.”
State and local leaders say that rule has been preventing some people from enrolling in Medicaid since Medicaid expansion began in January.
“This is a barrier,” said Jennifer Lee, Director of Virginia’s Department of Medical Assistance Services. “That’s what we’re learning.”
Lee says the issue has come up at community health centers and free clinics she’s talked to like Crossover Ministry in Richmond. Prior to Medicaid expansion, Crossover was serving only as a free clinic. But now, they’re accepting clients on Medicaid.
“We made a strategic decision to serve the Medicaid expansion population,” said Julie Bilodeau, Crossover Ministry CEO. “It’s been a transition for us.”
Crossover served about 5,500 people through their free clinic. 56% are native Spanish speakers, and another 10% have a native language other than English.
“It’s a really international patient base,” said Bilodeau.
They hoped to have enrolled nearly 2,000 of their free clinic patients in Medicaid already. But so far, only about 500 are now receiving Medicaid.
“We thought that number was going to be much higher,” said Bilodeau.
One of the issues preventing more people from signing up, she said, has been the 10-year work requirement.
It’ll be up to Virginia lawmakers to change or keep that requirement. Virginia Senator George Barker and Delegate Mark Sickles introduced a matching budget amendment to end the 10-year rule earlier this year.