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in hospitals, but in nursing homes there is a limit to how much of the cost can be shifted, because Medicaid patients account for a high percentage of the patients.

Many nursing homes across the state are already losing money, and may decide that they can no longer afford to be in the business.

In addition to chronically underpaying its health care providers, Virginia’s eligibility criteria strictly limit who can receive health care through the Medicaid program.

These two factors — low payment levels and restrictive eligibility rules — explain why Virginia’s annual Medicaid expenditures are about $1.5 billion less than the average amount spent by other comparably sized states.

Strict eligibility criteria helps to contribute to the number of uninsured individuals in Virginia, and at last count, there were more than one million, or about 15 percent of the state’s population.

The high number of people without insurance is one of the major reasons that Fauquier Hospital provided $4.3 million in free care in 2003. And the financial losses represented by free care are in addition to the losses associated with underpayment.

If you have health insurance, no doubt you’ve seen some changes in the past year. Your share of insurance premiums may have gone up, your deductibles may have

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