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Utah Now Has Full Medicaid Expansion, With Restrictions

Stock photo of medical equipment on a table.
Utah is one of 38 states to have implemented full Medicaid Expansion. Only Idaho and Nebraska are still in limbo.

The federal government has given Utah’s “Fallback Plan” on Medicaid Expansion the go ahead, bringing a long and drawn-out process closer — though not all the way — to its end. 

The Fallback Plan was the last of two backups state lawmakers wrote into S.B. 96, the bill that replaced last year’s voter approved ballot initiative to fully expand Medicaid coverage under the Affordable Care Act.

Now Utahns making up to 138% of the Federal Poverty Level — $17,236 for an individual — are eligible for Medicaid coverage. But they will also be subject to a work requirement, which will involve an online assessment and job search reports to maintain coverage. There’s also a stipulation that recipients must enroll in employer-sponsored insurance if they have that option. Federal approval of those provisions had been holding up Utah’s full expansion status.

The plan now opens Medicaid up to about about 80,000 more people statewide, according to the Utah Department of Health. Right now, there are roughly 287,000 people on the program in Utah, including 40,000 that signed on when the state implemented limited expansion last April. 

“It's revolutionary for low income folks,” said Stacy Stanford, health policy analyst for the nonprofit healthcare advocate Utah Health Policy Project. “This Medicaid expansion is a once in a generation opportunity to improve public health and to improve the lives of our neighbors who are just struggling to make ends meet.”

The latest expansion also takes part of the burden off the state, which will now pay 10% of Medicaid costs and leave the remaining 90% to the federal government. Prior to the approval, the state paid for 30% because it had not fully expanded. 

State Sen. Allen Christensen, R-North Ogden, sponsored S.B. 96. He said he’s happy with the savings but raised other concerns over the increased number of Medicaid patients. 

“There are going to be lines if all [these] people sign up,” he said. “I've said from the beginning that having Medicaid doesn't mean the same thing as getting healthcare.”

Christensen said there are a limited number of providers who accept Medicaid in Utah, so adding tens of thousands of more people to the program will increase the bottleneck for treatment and services.

But Stanford said that concern is overblown. 

“That doesn't come through as much in the data,” she said. “Those shortages, they're seen just as much in private insurance.”

The saga isn’t over yet. While the Center for Medicaid Services approved the core waivers needed to expand Medicaid by Jan. 1, there are several others the state is asking for that have yet to be approved. Those include raising premiums for those making above 100% of the federal poverty level and the potential to impose lockout periods if someone has an intentional program violation.

Jon reports on quality of life issues, education and the economy
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