SALT LAKE CITY — With a Friday projection from the Associated Press that Proposition 3 will have enough votes to pass, full Medicaid expansion is set to become the law in Utah, and Department of Health officials have asked the federal government to cancel the agency's request for a more limited form of expansion that state lawmakers set into motion earlier this year.
Once certified as law, the ballot initiative will supersede the expansion plan the Utah Legislature had passed, said Kolbi Young, spokeswoman for the Utah Division of Medicaid and Health Care Financing at the Department of Health.
"We have actually asked (the Centers for Medicare and Medicaid Services) … to indefinitely hold off on consideration of that proposal as a result of Proposition 3," Young said.
State health officials are also assisting the Utah Department of Workforce Services prepare for an influx of newly eligible Utahns signing up for the federal health insurance program.
"We've closely reviewed the proposition, and have coordinated internally on how to best move forward to meet that April 1 deadline. We are getting systems in place so we are able to open enrollment on April 1," she said.
The Department of Workforce Services is the agency that actually processes all new Medicaid enrollees' applications, Young explained.
"We have been in close contact with them, so they were prepared with their staff and increasing their staffing to handle that surge of enrollment," she said.
In addition to sign-ups beginning in April, Utahns will at that time see a rise in the state sales tax included in Proposition 3 to help pay for full Medicaid expansion. The tax on nonfood items will increase from 4.7 percent to 4.85 percent.
The Proposition 3 campaign, Utah Decides Healthcare, has estimated the increase will add $91 million in state revenue, triggering about $800 million in guaranteed matching federal funds, to pay for a projected 150,000 new enrollees in the insurance program.
Proposition 3 expands Medicaid eligibility to all Utahns in households earning 138 percent of the federal poverty level.
The bill passed by the Utah Legislature this year aimed to expand eligibility to everyone at 100 percent or less of the federal poverty level, leading to 70,000 to 90,000 new Medicaid enrollees. But asking for a 90 percent-to-10 percent federal matching rate without expanding Medicaid to the full extent provided for under the Affordable Care Act would have subjected it to a lengthy and less certain waiver approval process conducted by the Centers for Medicare and Medicaid Services.
Supporters of that measure said it had better financial safeguards for the state than the initiative and that the Trump administration had shown an openness to supporting partial expansions at a 90-10 matching rate. But critics, including several Utah health advocates, predicted it would have very little chance of approval.
Because it calls for Medicaid eligibility expansion precisely as called for by the Affordable Care Act, Proposition 3 does not need to undergo a waiver approval process, and enacting the expansion it calls for is relatively painless and automatic, said RyLee Curtis, manager of the Utah Decides Healthcare campaign.
"There's still a process that the state has to follow, through submitting what's called a state plan amendment," Curtis said. "But since we're playing within the boundaries of federal law, this should be very procedural and very quick."
There is no cap on new enrollment included with Proposition 3. Because of that, some critics have said the state budget could be left vulnerable to higher-than-expected numbers. But the initiative campaign has argued it tried to cushion its projections to make sure it wasn't guilty of underestimation.
Maura Carabello, a consultant for the Utah Decides Healthcare campaign and the president of Salt-Lake based Exoro Group, a public policy group that helped get Proposition 3 drafted, estimated to the Deseret News and KSL editorial boards in August that about 100,000 or perhaps a slightly higher number of the expected new sign-ups will come in the first year of expanded eligibility.
Young said Utah organizations that specialize in helping people enroll in federal health insurance programs will play a role in helping manage the new wave of sign-ups.
"For years we have worked in close contact with advocacy organizations to help individuals apply," she said. "That relationship will continue."
Take Care Utah, a collaborative network of about 50 nonprofits that help Utahns sign up for Medicaid, the Children's Health Insurance Program and private coverage plans on the federal health exchange, is prepared for the large task and grateful to give more people the good news that they are eligible, said director Randal Serr.
“When Obamacare first rolled out, half of the calls we got were people that were in the Medicaid gap. We had to turn way too many people away," Serr said. "We are thrilled to be able to tell those people that they now qualify for health insurance.
"We spent the past six years building trust with the community and we are excited to get the word out. By working with community partners and media, we are ready to hit the ground running on April 1."
Young said about 15,000 enrollees in a different, state-administered health program called the Primary Care Network, which offers more limited medical benefits for certain preventive services, were previously ineligible for Medicaid and will be automatically enrolled in it as a result of Proposition 3 when it takes effect April 1.10 comments on this story
"Instead of them having a limited benefit package, they'll have a richer benefit with Medicaid," she said.
Curtis said she is looking forward to the improved outcomes she believes some newly insured Utahns will see as they access the health care system with more confidence and less worry about possible financial hardships.
"When you have a chronic condition, (and) you maintain it," she said, "you're not going to the emergency room (and) driving up costs for yourself and for everybody else."