To Children's Hospital of The King's Daughters, there's a glimmer of hope in the House version that exempts certain hospitals from cuts in Medicaid reimbursement rates.
"We wouldn't fit any of those descriptions," said George Phillips, Riverside's director of strategic support services.
The House and Senate, trying to plug a $2 billion shortfall, released budgets Sunday that make significant cuts to health and human services and education.
The cuts are on top of about $2 billion in cuts proposed by former Gov. Timothy M. Kaine late last year. Those cuts included reducing Medicaid reimbursement rates paid to hospitals.
Virginia is already among the lowest in Medicaid reimbursement rates, ranking 48th, according to the Virginia Hospital and Healthcare Association.
The House version spares those cuts at teaching hospitals, critical access hospitals and hospitals serving a high number of Medicaid patients. Riverside doesn't fit that description, but CHKD does. More than half its patients are on Medicaid.
"That is possibly the one positive glimmer of light on the horizon for us," said Jim Dahling, president and CEO of CHKD. "The devil is in the details. We'll probably have a better picture later this week. It all depends on how they define that."
The Senate bill postpones cutting Medicaid reimbursement rates for a year, in hopes that federal aid will come through. It also restores funding to free medical clinics, community health centers and dental services for the poor.
"I think the Senate version, at least on paper, looks a little better," Phillips said.
But exactly how health systems will be affected is still up in the air. Only budget summaries were released. The exact language won't be made available until today at the earliest, Phillips said.
"We won't know any real specifics until then," he said. "Until I see the language, I couldn't tell you exactly what those impacts in dollars and cents will be. Probably by late Wednesday or Thursday, we'll have a more accurate picture of what the budget looks like. It's not pretty."
Local health systems have cut about 750 jobs since late 2008, mostly due to budget shortfalls. More jobs may be cut and services curtailed if Medicaid reimbursement rates are reduced, health officials have said.
"I know we can't get away from cuts because of the state finances, but these cuts are going to hurt across the board," Phillips said.
The brunt of the $200 million House plan cuts are born by Medicaid and FAMIS, a program that subsidizes health insurance for children of the working poor. Cuts are also made in payments to hospitals, nursing homes, dentists, physicians and personal care assistants for homebound patients. Tighter eligibility requirements will force some higher-income recipients off the Medicaid and FAMIS rolls.
That means those people won't seek medical care until they really need it, Phillips said.
Hospitals are already seeing a "mushrooming" of charity care, and that could make it worse, he said.
The House and Senate will vote on their own plans Thursday, and then negotiators will work out the differences between them.
The Associated Press contributed to this report.