If Medicaid is expanded in Virginia, it likely will happen only with serious tinkering by state lawmakers.

As part of a budget bill that keeps the proposal alive, the General Assembly over the weekend created a legislative commission that will determine how Virginia applies one of the key provisions of the new federal health care law.

Under the Patient Protection and Affordable Care Act, states have the option of broadening Medicaid eligibility so that more low-income individuals are covered by the government insurance program.

But rather than accept the idea — and the federal funding that comes with it — outright, the General Assembly has made it contingent on whether suggested improvements to the federal proposal are deemed acceptable by the state commission.

That process will take months to play out, raising questions about whether the state will meet the Affordable Care Act’s goal of having the expansion in place by Jan. 1, 2014.

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