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Ravell Call, Deseret News
Ruby Hammel, left, hugs Seema Verma, administrator of the Centers for Medicare and Medicaid Services, after the administrator met with Medicare beneficiaries at the AARP Utah state office in Midvale on Monday, Nov. 13, 2017.

SALT LAKE CITY — Anyone targeted by the Medicaid expansion waiver approved this month became eligible as of Monday to be reimbursed by the federal program, Centers for Medicare and Medicaid Services administrator Seema Verma announced during a visit to Utah.

"I’m … very pleased to announce today, not only have we (approved) the waiver, we also approved the implementation plan that Utah put forward," Verma said at a press conference flanked by Gov. Gary Herbert and state Rep. Jim Dunnigan, R-Taylorsville, at the Odyssey House addiction treatment center.

"And so starting today people in Utah — individuals who are on the Medicaid program, providers — they can receive immediate reimbursement for these types of services."

Medicaid enrollment itself has been available to an additional 4,000 to 6,000 of some of Utah's very poorest since Nov. 1, the day Centers for Medicare and Medicaid Services approved an eligibility expansion requested by the Utah Legislature in 2016.

The Centers for Medicare and Medicaid Services' approval of the waiver also included lifting a decades-old restriction barring the use of Medicaid funds at addiction treatment centers with more than 16 beds. That change, combined with Utah's homeless receiving Medicaid coverage, "creates an incredible opportunity for Utah to address the opioid crisis," said Adam Cohen, CEO of Odyssey House.

"On the ground level, this waiver is going to save many, many lives," he said.

Cohen predicted to the Deseret News earlier this year that getting an exception to the rule could make waitlists for addiction treatment "dramatically decrease overnight" for low income Utahns.

"While waiting, people were unnecessarily dying. … This is a watershed moment for people needing addiction treatment and I am so excited for (Odyssey House) to be a part of that," Cohen said Monday.

Dunnigan, the sponsor of the state's legislation requesting the waiver, was exuberant Monday, giving Verma a high-five after her announcement.

"We can change lives, and that’s what we’re about," he said.

The waiver opens up $70 million in federal Medicaid as well as $30 million from the state level. Those who were made newly eligible for Medicaid are Utahns without children who earn 5 percent or less of the federal poverty level — and are either chronically homeless or involved in the criminal justice system via court-ordered substance abuse or mental health treatment, or on probation or parole.

Of the $100 million in funding opened up, $10 million will go toward funding 240 new residential treatment beds by the end of 2017 as part of Operation Rio Grande, a comprehensive initiative by multiple state agencies to reduce drug dealing, addiction and crime generally in the area around the homeless shelter downtown.

Utah Department of Health officials, as well as state legislators such as Dunnigan, have been in talks with the Centers for Medicare and Medicaid Services since the infancy of President Donald Trump's administration about getting approval of the waiver. In August, the health department said it felt confident from its conversations that the approval could come by Nov. 1.

Though waiver approval has been in the works throughout that time, Verma also credited Trump's declaration of an opioid addiction national public health emergency last month as a springboard in Utah's request being finalized when it was.

"Absolutely, (the president's declaration) helped us move it through," Verma said. "In the past there would be all these difficult requirements for states to go through and it took them a long time. The previous administration was only able to (clear) four of these types of waivers, and since the president declared this, we've been able to do two and we know that we're going to have more."

In his remarks announcing the emergency, Trump said "you should expect to see approvals that will unlock treatment for people in need."

'Red-letter day'

Herbert called Monday's visit and announcement by Verma "a red-letter day" coming after "a longer journey than most of us would have liked."

Though the process has been long, the new moneys have been made available none to soon because of efforts to address the plight of drug addiction and homelessness in Salt Lake City, the governor added.

"We're actually creating a better environment in the downtown of our city," Herbert said. "This is going to go a long way toward us helping give (people) treatment and helping them become rehabilitated."

Dunnigan said some of the childless adults being made eligible for Medicaid "actually have children, they just don't have legal custody anymore," meaning the expansion will ultimately help more than just the new Medicaid beneficiaries themselves.

"If we can change one or two or more of these lives, we can change generations," he said.

Verma said coordinating with Utah leaders on the waiver approval "is a great example of how the federal government can work with states."

"States are innovators and they’re going to know what’s going to be best for the people that they serve," she said.


Earlier Monday, Verma met with AARP's top administrators in Utah at their offices and took questions from a roundtable of its members and volunteers.

There, Verma addressed a host of questions ranging from designing Medicare for an increasing number of Americans with Alzheimer's disease, to an upcoming change in recipients' Medicare cards to protect against identify theft, to negotiating drug pricing with pharmaceutical companies.

One person asked whether Verma anticipates the minimum age requirement, which is 65 for most beneficiaries, eventually being raised. She responded that the Trump administration has no intention of raising the minimum age.

"The president is absolutely committed to the Medicare and Medicaid programs. … He's always said, 'Let's make sure these programs are strong and we're protecting (them),'" Verma said. "He understands everybody's been contributing to this program their entire lives and they expect (it to be there)."

Alan Ormsby said Verma's reassurances are "comforting."

"I do think she did a good job of listening. She probably could have gone into a little bit more detail about future plans, but I was impressed that she focused so much on (reassuring people) that the program would survive and thrive really," Ormsby told the Deseret News.

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Asked whether a request for full Medicaid expansion in Utah would face any additional barriers if voters passed it as a ballot issue next year, Verma told the Deseret News, "We're going to follow the law."

She said the agency reviews requests to ensure they are "within the boundaries of the law" and that they don't present an exorbitant "burden to taxpayers," but otherwise tries to be as hands off as possible.

"We think that states are in the best position to make decisions … better than any Washington bureaucrat," Verma said. "Our job at CMS is to support states to get them where they want to go."