Utah's Medicaid waiver, which seeks to modify delivery and reimbursement methods, due Friday to feds

SALT LAKE CITY — In an effort to contain the growing costs of Utah's Medicaid system, officials are seeking to bypass federal rules and change how the program incentivizes local health care providers as well as charge participants higher co-pays.

Without reform of the current system, Sen. Dan Liljenquist, R-Bountiful, said he worries increasing costs and projected enrollment growth will eventually bankrupt the state and Medicaid overall.

"We have got to get a hold of Medicaid costs and this is a reasonable attempt to do so," he said. "It is designed to change the incentives for Medicaid and how we manage Medicaid, to make sure that we can live within our means."

Instead of paying for each service provided, the Utah Department of Health is proposing to give doctors and hospitals one lump sum per patient per month, potentially saving money in the long run, Liljenquist said.

"We write checks. That's what we've done with Medicaid. When bills come in, we write checks and that has just become so expensive that now we have to change the way we (incentivize) providers and participants in Medicaid and how care is delivered," he said.

Issues pertaining to Utah's Medicaid reform, which first need to be approved by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services, would require a transition from the current managed care model, to a model that groups providers who agree to be held accountable for improving health care quality while lowering costs into Accountable Care Organizations. That transition, UDOH spokeswoman Kolbi Young said, will likely be the most noticeable change in the program.

"The overall goal is to reduce the rate at which Medicaid expenditures are increasing," she said, adding that Utah's Medicaid costs have exceeded the state's revenue growth every year for the past two decades.

Changes have to be made "to improve the long-term sustainability of Medicaid," Young said.

Judi Hilman, director of the Utah Health Policy Project, said she supports the idea of reform but recognized "serious problems" in the initial plan, specifically with the portion of the cost that beneficiaries would be expected to pay.

"From our understanding of the changes needed to move Utah down the path toward accountable care, the (waiver) proposal makes a promising start; it also reflects a good deal of the positive input from stakeholders," Hilman said. "But we also knew going into this where the trouble spots would be for beneficiaries: around cost sharing obligations, access to primary care, and coverage of benefits."