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Ex-governor's letter could help McAuliffe expand Medicaid in Virginia

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A letter from then-Gov. Bob McDonnell to U.S. Health and Human Services Secretary Kathleen Sebelius asserts that the governor has the power to expand Medicaid in Virginia – with or without General Assembly approval.

McDonnell’s March 5, 2013, letter declared: “As governor … the decision currently rests with me on whether or not to expand (Medicaid).”

McDonnell added that he had no intention of unilaterally enlarging the indigent-care rolls, saying he would wait for the Medicaid Innovation and Reform Commission to complete its analysis, due at the end of this year.

But McDonnell’s successor, Democratic Gov. Terry McAuliffe, is not so restrained. He has vowed not to sign any budget that fails to extend Medicaid coverage to 400,000 more Virginians.

Though McDonnell’s language suggests that the chief executive has the authority to counter any legislative opposition on Medicaid, the extent of gubernatorial power is up for debate.

Matthew Moran, spokesman for House Speaker Bill Howell, told Watchdog.org: “We firmly believe that the authority to expand Medicaid rests with the Medicaid Innovation and Reform Commission, not with the governor.”

“None of the Republican House leadership thinks he has a legal route, primarily because the legislature controls the purse,” said Craig DiSesa, who heads Middle Resolution, a group fighting Medicaid expansion.

Yet, DiSesa added, if lawmakers “kill the MIRC and give (state Health and Human Resources Secretary) Bill Hazel the power, then the governor would have the power to expand.”

McDonnell’s letter was written before the creation of MIRC.

“My personal take is that no one really knows except the governor’s inner circle,” DiSesa said. “There will likely be legal action if (McAuliffe) tries” to expand Medicaid on his own.

McAuliffe spokesman Brian Coy did not respond to Watchdog’s request for comment by deadline.

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