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Health Officials Take Comment On Utah's Medicaid Expansion Proposal — Here's What To Know

Photo of medicaid form. / jwblinn

The public will have a chance to weigh in on the last step towards implementing the Utah Legislature’s Medicaid expansion plan during a hearing on Thursday afternoon.

The meeting at the Utah Department of Health is being held to gather public feedback on the second of two requests the state must submit to the federal government before to start enacting SB96. The proposal signed into law in February would expand low-income health coverage to an estimated 70,000-90,000 Utahns who earn up to 100% of the poverty level — about $12,490 for an individual or $25,750 for a family of four.

Why does Utah need a waiver from the federal government to expand the program?

Medicaid is a state-federal partnership. That means when states want to change how the program works, they need to first get permission from the Centers for Medicare and Medicaid Services (CMS) with requests known as waivers. The current waiver being submitted by the Utah Department of Health includes a number of elements of SB96, some of which are controversial and others not.

What’s in this waiver and why is it controversial?

The waiver has 15 requests, the most significant of which include capping the amount of Medicaid funding coming to Utah and adding a work requirement or “community engagement requirement” for some individuals in exchange for getting health coverage. Another important, but little-discussed option would allow the state to cap enrollment in the Medicaid program.

“The enrollment cap is unprecedented,” said Joan Alker, the executive director of the Center for Children and Families at Georgetown University, a group that frequently advocates for Medicaid expansion.“That is a violation of the fundamental nature of the Medicaid program, which is that if you’re eligible, you get it. The state can’t decide ‘Oh, you lost your job in September, you’re not going to get it. If you lost your job in March, you are going to be able to get Medicaid.’”

Enacting this provision could set a precedent for other states to follow if they want to shrink enrollment in the program, Alker said.

Why is there a need for an enrollment cap?

According to language in the proposal, enrollment caps are included to prevent the Medicaid program from cutting into the state’s general fund.

The request, the proposal states, is being made to “allow the State to be able to continue to furnish medical assistance to approved populations in a fiscally sustainable manner and within the budget conditions that the State faces now and may face in the future.”

Also included are requests to add dental benefits for Medicaid recipients receiving treatment for substance use disorder, Medicaid eligibility up to a year and housing support services for individuals experiencing homelessness.

Is this Medicaid expansion plan likely to change?

Once submitted, CMS can choose to approve or deny any parts of this waiver. The first proposal for SB96, however, was approved without delay.

“A lot of the time members of the general public aren’t necessarily going to get involved in the legislative process,” said Tom Hudachko, a spokesman for the Utah Department of Health. “But they may be more inclined to get involved in a public comment process like this. People’s comments carry weight.”

What’s next?

Two public hearings will be held. The first is Thursday followed by another on June 17. Online public comments are being accepted through June 30.

This waiver must be approved by Jan. 1, 2020 to enact the full scope of SB96. If it’s not approved, the Legislature included two fallback plans — a more robust Medicaid expansion plan and full Medicaid expansion as voters approved it under the Proposition 3 ballot initiative in November.

Erik Neumann is a radio producer and writer. A native of the Pacific Northwest, his work has appeared on public radio stations and in magazines along the West Coast. He received his Bachelor's Degree in geography from the University of Washington and a Master's in Journalism from UC Berkeley. Besides working at KUER, he enjoys being outside in just about every way possible.
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