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Utah Medicaid Expansion Update April 1, 2019

Posted on 04/15/2019 12:00 am  

On February 11, 2019, Governor Herbert signed Senate Bill 96 (2019 Legislative Session) into law. This bill supersedes previous Medicaid Expansion efforts and replaces Proposition 3 (2018 General Election).   The street name for this is called the “Bridge Plan”, which proved to be to be supported by CMS.  Here’s what happened April 1st:

  • This new law expands Medicaid to parents and adults without dependent children earning up to 100% federal poverty level.
  • New applications are being accepted right now. (April 1 Start Date)
  • Approximately 40,000 individuals from 101-138% FPL will continue to receive services through the federal Marketplace.
  • 17,500 PCN members will automatically be enrolled in the new Medicaid plan.
  • Work effort requirement Starts Jan 1, 2020.
  • Funding of this plan is 70% fed 30% state.

What’s Next?

This spring, the State will also submit a new 1115 Waiver to CMS called the “Per Capita Cap Plan.” This plan will replace/add to the Bridge Plan above and will be effective upon CMS approval. The Per Capita Cap Plan covers adults up to 100% FPL and requests the following provisions: self-sufficiency requirement, enrollment cap, up to 12-month continuous eligibility, employer-sponsored insurance enrollment, lockout for program violation provision, and a per capita cap. This plan will also request 90% fed 10% state funding.

Utah’s plan/waiver got approved while others states did not.  A federal Judge struck down Kentucky and Arkansas work requirement.  It is important to note that Utah does not have a work requirement. It has a work “effort” law.  Enrollees must seek job opportunities and training. This requirement will be challenged but will likely stand.

Possible outcomes if future waivers aren’t approved by CMS:  Click here.  Yes, there is a backup plan for everything.  The “Per Capita Cap Plan” is the win-win scenario that benefits all parties and is the goal for the State.

UAHU’s lobbyist, Mike Sonntag, and legislative co-chair Shane Skeen have been hard at work following these options and created a detailed summary for our members. For the full detailed version of the changes click here.


8 Reasons Why Utah Didn’t Expand Medicaid to 138%

Posted on 04/15/2019 12:00 am  

As a follow-up to UAHU’s Utah’s Medicaid expansion explanation some of you have wondered why Utah did not just adopt prop 3 as voted for.

Let’s take a look at 8 Reasons why Utah didn’t expand Medicaid to 138%

–       Outdated Numbers:  Prop 3 was written based on 2017 numbers and there were mistakes in the language.  The citizen initiative process requires that the language cannot be changed once signatures start being collected, even though no citizen initiative has ever been left unchanged.

–       Insufficient Funding: Prop 3 had a .15% sales tax increase.  This amount was not enough to cover the new medicaid expenses.  The legislative fiscal analyst office estimated that after the first year they would be $11million short, then $45million the following year. By the end of the third year it would be $65million short.

–       Provider Reimbursements: Prop 3 had a  2% year in year out reimbursement increase for Medicaid providers, which is not sustainable.

–       Unlimited Cost: Prop 3 had no cap on enrollees or costs. Utah constitution requires a balanced budget which without caps is impossible to maintain.

–       Insufficient Plans: Prop 3 enrolled those people in the 100-138% gap with low cost, $10 copay, no deductible plans though the Federal Exchange into inferior Medicaid plans. The federal subsidies match in the exchange is $400 million. Medicaid proponents have never acknowledge this number, constantly saying we are leaving $600 million on the table.

–       Inaccurate Marketing: A current ad targeting Representative Dunnigan and Senator Christensen is exaggerated and funded by out of state money. The claim that three VIVINT Smart Home Arenas could be covered by Medicaid if we expanded to 138% is overstated since many of the members are already insured in the private market and subsidized through the Federal Exchange.

–       Limited County Support: Prop 3 did not pass in 21 out of 29 counties. Legislators did not feel there was a mandate to leave it unchanged given this fact.

–       False Pretense for Support: Prop 3’s proponents collected signatures under false pretenses saying that children would finally be able to receive medical care. Utah Medicaid has always covered children under the current program.

Utah’s current expansion plan provides a way for all to be insured. In case you missed it, read a full review by our Legislative Team of the current expansion plans and options here