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Ravell Call, Deseret News
Ginger Phillips asks a question about the state Medicaid program during a public hearing at the Utah Department of Health in Salt Lake City on Thursday, May 17, 2018.

SALT LAKE CITY — State health officials heard public input Thursday on their efforts to petition the federal government to expand Medicaid coverage to tens of thousands more Utahns.

The state Legislature's 2018 law seeking to expand Medicaid would make Utah the first state to qualify for a 90 percent federal funding match without making coverage available to everyone in households with incomes under 138 percent of the federal poverty level.

That's according to Nathan Checketts, director of Medicaid and Health Financing for the Utah Department of Health, who took comments Thursday from those concerned with the request's chance of being approved.

Checketts also answered questions about the proposed expansion's accompanying work requirement and how its status might be affected by a competing, more extensive Medicaid expansion initiative expected to go before voters in November.

The questions were raised at the second of two public meetings on the state's expansion waiver request held by the Utah Medical Care Advisory Committee.

Courtney Bullard, education and collaborations director for the policy advocacy group and insurance enrollment hub Utah Health Policy Project, said the organization opposes the expansion request because it believes it has little to no chance of being approved.

"We applaud ... the Utah Legislature and the Utah Department of Health for their efforts in addressing the coverage gap," Bullard said, referring to those who earn too much to qualify for Medicaid but to little to get insurance on the federal health plan marketplace.

"(But) we are opposing this waiver request because of the harmful elements it contains and because we do not have any reason to believe it will be approved by the federal government."

Bullard added that the proposal "stands on shaky legal ground and gives false hope to Utahns in need of care."

Bullard told the Deseret News that the Affordable Care Act makes no legal provision allowing states to expand Medicaid coverage and pay for it using a 90 percent federal funds match, unless that expansion covers everyone up to 138 percent of the federal poverty level as the law intended.

The request passed by the state Legislature seeks to ensure eligibility for Utahns earning up to 100 percent of the federal poverty line.

Supporters of the state Legislature's version of Medicaid expansion have argued the current U.S. Health and Human Services administration has shown a willingness to be open-minded to Utah's request, and have said the new measure would not be expected to raise taxes in the state. It is estimated it would make between 70,000 and 90,000 Utahns newly eligible.

A ballot initiative campaign called Utah Decides Healthcare is hoping to convince Utahns to agree to a sales tax increase to expand coverage to all Utahns up to 138 percent of the federal poverty level, making an estimated 150,000 people newly eligible.

Beth Noyce, executive director of the Utah Association for Home Care, asked Checketts what could happen to the state's Medicaid expansion waiver request if the ballot initiative is passed.

"Will this waiver then be obsolete?" Noyce said.

Checketts responded that health officials are currently unsure about that.

"We have asked that same question of our attorneys," Checketts said, and as of Thursday, "We haven't received that (legal) opinion."

Christine Evans, a Utah Medical Care Advisory Committee member, said she had concerns about the work requirement included with the state's Medicaid expansion request and "how that affects people with disabilities and people who really cannot work."

Checketts answered that "there's a fairly long list that we've exempted" which includes "individuals that are not officially disabled by Social Security (eligibility) standards, but have disabling conditions."

Other groups exempted from the work requirement include people 60 years old or older and those who have a child under the age of six in their home, Checketts has explained previously. Besides employment, other related efforts including a job search or job training could satisfy the work requirement, he has said.

Other Medicaid reforms

The Department of Health is also preparing to submit requests to the federal government for each of the following:

• The ability to provide "crisis stabilization services" coverage to Medicaid youth and family members for scenarios in which a person 21 or younger is at risk of being put into state custody.

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• The ability to expand family planning services coverage to most Utahns between 19 and 64 years old, who belong to households earning up to 100 percent of the federal poverty level but are not otherwise currently eligible for Medicaid. Per Checketts, this request would be null if full Medicaid expansion is approved, since the same group would become eligible for comprehensive coverage that includes family planning services benefits.

• The ability to give dental benefits to certain Medicaid recipients undergoing treatment for substance use disorder.

According to Checketts, the Department of Health will submit each of its requests, including the application for large-scale Medicaid expansion, by June 30.

Anyone who did not submit a comment at either of the public meetings can still do so on the state's Medicaid website, medicaid.utah.gov, through May 31.