Utah's 'Fallback Plan': The Latest On The State's Medicaid Expansion Saga | KUER 90.1

Utah's 'Fallback Plan': The Latest On The State's Medicaid Expansion Saga

Oct 7, 2019

The Utah Department of Health is holding public hearings this week on the latest installment of the state’s Medicaid expansion program. The move comes after the Centers for Medicare and Medicaid Services (CMS) sent out an informal rejection in July to several states considering plans like Utah’s, forcing state lawmakers to regroup. 

The plan currently under review is what is known as the “fallback plan.” It’s the last of the alternatives written into S.B. 96, which Utah lawmakers signed earlier this year after scaling back the original ballot initiative voters approved in November. 

Under the fallback plan, the income cap would return to the same full expansion levels that voters approved under Prop. 3. It would offer coverage to Utahns making up to 138% of federal poverty levels — $35,535 for a family of four. That would give roughly 150,000 Utahns access to Medicaid, as opposed to the 70-90,000 covered right now.

The 2019 Federal Poverty Level is used to calculate Medicaid and CHIP eligibility. It's based on Modified Adjusted Gross Income (MAGI). Levels are different for Alaska and Hawaii. These figures are not used to calculate Marketplace insurance costs. Source: 

https://www.healthcare.gov/glossary/federal-poverty-level-FPL/ , https://aspe.hhs.gov/poverty-guidelines

If the plan goes through, lawmakers would be able to shift more of the financial burden back to the federal government, which would contribute 90% of the program’s costs. The remaining 10% would be left to the state. 

Lawmakers also kept a number of restrictions in the plan that would require a federal waiver. Those include a controversial work requirement and a potential cap on enrollment, which could limit the number of eligible Utahns. 

“The fallback plan is essentially the full expansion with cost-control measures,” said Stacy Stanford, health policy analyst with the advocacy group Utah Health Policy Project. 

Stanford noted the fallback plan also includes a final provision that would allow the state to make further changes if the legislature finds costs exceed its budget.

The Department of Health is required by federal guidelines to seek public comment on Medicaid proposals. Stanford said that even if voters have been frustrated by the process so far, public input can have a meaningful impact on the program’s outcome.

“It takes it out of the hands of elected officials and into the hands of a judge,” she said, adding that federal judges who review the proposals take comments into consideration when making their decisions. The work requirement, for example, has been overturned in three other states, which Stanford said was due in part to public feedback. Still, the Trump administration did approve Utah’s work requirement in March as part of an earlier version of the partial Medicaid expansion plan.

Utah’s public comment period will remain open until October 27. If the fallback plan is rejected, or the Trump Administration fails to make a decision by July 2020, the original full expansion would go into effect.