The Shadow
RICHMOND, Va. (VR) – 181 members of the Virginia Health Care Association – Virginia Center for Assisted Living (VHCA-VCAL) will file a petition before the Supreme Court of Virginia against the Virginia Department of Medical Assistance Services (DMAS) for failing to modify nursing facility direct care base rates as expressly directed by state budget approved by the General Assembly in April. The petition asks the court to issue a writ of mandamus to require DMAS to increase the nursing facility reimbursement rates using the methodology required by the General Assembly. DMAS is illegally relying on an attempted veto by Gov. Glenn Youngkin that did not follow the requirements of the Virginia Constitution. The official law of Virginia does not record or recognize this attempted veto.
The nursing home petitioners include for-profit and not-for-profit providers, multifacility organizations and single site, standalone providers. These nursing homes are located across the Commonwealth, from Accomack County to Lee County, from Berryville to Clarksville.
“We had hoped it would not come to this, but VHCA-VCAL members have an obligation to exhaust every opportunity, including legal action, to ensure the care Virginia’s nursing home residents rely on for 24/7 support is funded appropriately. This legal action is really about patient care for some of our most vulnerable fellow citizens. It is imperative that nursing homes have the resources they need to appropriately staff facilities and provide their residents with the high-quality care they deserve,” said Keith Hare, president and CEO of VHCA-VCAL.
“The governor’s unconstitutional veto is having a serious impact on the ability of nursing homes to hire and retain staff. This is especially distressing as we know robust Medicaid funding is critical for continued quality care for Virginia’s seniors. Virginia must continue to invest in Medicaid nursing home care, not undermine efforts intended to boost the nursing workforce,” Hare added.
VHCA-VCAL successfully advocated for a base rate methodology change during the 2025 General Assembly session because too many nursing homes face a funding gap between the cost of care and what Medicaid pays because the Medicaid base rate remains too low. Approximately 39 percent of Virginia’s nursing homes are reimbursed less under Medicaid than they already spend on nursing staff. Modifying the base rates by increasing the percentile of cost coverage decreases the number of nursing homes that face this funding cap for resident care.
In the petition, the nursing homes argue that DMAS has no legal authority to refuse the General Assembly’s unequivocal command to modify the nursing facility direct care base rate calculations for nursing home reimbursement. DMAS has taken no steps to modify its calculations using the updated methodology. As a result, these nursing homes will receive reimbursements from DMAS that are less than the reimbursements they would receive under the General Assembly’s required methodology. This affects the ability of Virginia’s nursing homes to maintain staffing levels and provide quality care to their residents.
Under previous rulings of the Supreme Court of Virginia, a governor has the ability to veto an “item” within a budget bill, but a governor cannot veto a condition of an appropriation without also vetoing the money appropriated. That is what Governor Youngkin did here: he vetoed the portion of the budget bill requiring DMAS to implement new rates with a new methodology, but he did not veto the money the General Assembly included in the budget bill to fund those increased rates.
The Supreme Court of Virginia has jurisdiction under the state constitution to issue a writ of mandamus to compel a government official to comply with a mandatory, non-discretionary duty. The Supreme Court has used that jurisdiction when deciding previous cases involving item vetoes by previous governors. DMAS has no discretion to refuse the General Assembly’s command to modify nursing home rates.
VHCA-VCAL’s members operate over 96 percent of Virginia’s Medicaid nursing facility beds and nearly seven in ten individuals in nursing facilities rely on Medicaid for their care. As a health care provider that relies almost entirely on government reimbursement (Medicaid and Medicare), nursing homes cannot address their workforce issues on their own.
