Utah Medicaid Expansion Update April 1, 2019

Utah Medicaid Expansion Update April 1, 2019

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.