SALT LAKE CITY — Utah's "bridge" program to expand Medicaid to about 70,000 to 90,000 adult Utahns got federal approval Friday — meaning eligible adults can apply starting Monday.
The Centers for Medicare and Medicaid Service approval of Utah's program comes after the Utah Legislature earlier this year passed a replacement to the voter-approved Proposition 3, which would have fully expanded Medicaid.
Instead, Utah lawmakers passed a more limited plan, extending Medicaid coverage for Utahns earning only up to 100 percent of the approximately $12,000 federal poverty rate — not up to 138 percent covered under the full expansion in Proposition 3.
Leading up to lawmakers' passage of the plan, SB96, critics questioned whether the federal government would approve the waivers needed for Utah's plan, while lawmakers said they had been given indications that the waivers would be approved. Approval for the first part of Utah's program came Friday.
“It isn’t easy to design a program that cares for the whole needs of a person, including the social determinants that we know have such a large impact on health like work and community engagement,” said Seema Verma, Centers for Medicare and Medicaid Service administrator, in a news release.
“Gov. (Gary) Herbert and his team have shown tremendous leadership by developing a sustainable Utah solution that extends coverage while helping to lift families from poverty instead of trapping them in public assistance,” Verma said.
Critics on Friday continued to blast the Utah Legislature for limiting Medicaid expansion rather than allowing Proposition 3 to take effect, which would have covered an estimated 150,000 Utahns.
"This waiver leaves more than 50,000 Utahns without health insurance and sends billions of our tax dollars back to Washington," said Andrew Roberts, spokesman for Utah Decides, the group behind Proposition 3. "In their rush to overturn the will of the voters, politicians cooked up a backroom deal that leaves us paying three times as much per person covered."
Under the newly approved plan, Utah residents who earn up to 100 percent of the federal poverty level — about $12,492 for an individual or $25,752 for a family of four — will be eligible to receive full Medicaid benefits, according to the Utah Department of Health.
The federal government will cover approximately 70 percent of the cost of the new program while the state of Utah will cover the remaining 30 percent. Utah's other waiver request to move to a 90 percent and 10 percent split still awaits approval.
“This is an important first step in covering vulnerable Utahns in a financially sustainable way,” Herbert said in a prepared statement. “But it’s just a first step. In the coming months, we will submit a detailed proposal seeking a new funding arrangement with CMS that will decrease the state’s share of the costs, provide the federal government with assurances on its costs, and provide the state with additional flexibility to manage the program.”
House Speaker Brad Wilson, R-Kaysville, was out of town Friday, but his spokesman, Matt Lusty, told the Deseret News "he's very excited" about the approval.
"This is an important step as we expand Medicaid and make sure that we take care of the most vulnerable among us in society," he said. "We need to do so in a way that protects the state budget, and this is the first and most important step."
Friday's approval paves the way for Monday's partial expansion, known as a "bridge" plan, a temporary plan requiring more state money to expand Medicaid to Utahns earning below 100 percent of the federal poverty level.
Friday's federal approval also allows the state to cap enrollment in the program if there are insufficient state funds available to match the federal funds. It also includes authorization to implement a self-sufficiency requirement and to require eligible individuals to enroll in their employer-sponsored insurance plans, if available. However, these two requirements will not be implemented until January 2020, according to the Utah Department of Health.
Utah's alternative Medicaid expansion plan imposes certain requirements on enrollees, requiring different terms from the Affordable Care Act.
Days ago, a federal judge struck down Medicaid work requirements in Kentucky and Arkansas, leading critics to ponder the possibility of whether Utah's program could be legally challenged.
"There are still so many question marks in the air," said Stacy Stanford, policy analyst for Utah Health Policy Project. "So much of this is unprecedented. … It's really stunning that they're still approving this two days later, when Utah's case will very likely go to the same court, to the same judge, to the same ruling. So it's very brazen. It's a very brazen attempt to limit Medicaid."
Tom Hudachko, spokesman for the Utah Department of Health, told the Deseret News that that work requirement portion of Utah's program isn't expected to be rolled out until Jan. 1, 2020, so Friday's approval likely won't be affected by the court case.
Whether it will in the future remains to be seen, Hudachko said, though he noted Utah's work requirements are quite different than those challenged in other states.
While those states require people to be employed and work a number of hours every month, Hudachko said Utah has exemptions that can allow people who aren't employed to still be covered. They would need to complete certain requirements to be eligible, including an online assessment, online training programs and at least 48 job searches within the first three months.
Later this spring, the Utah Department of Health will submit the second waiver request to the Centers for Medicare and Medicaid Service. In addition to seeking to raise the federal share of the cost of the program to 90 percent, it will include provisions such as a cap on federal funding, the ability to provide housing supports, and allowing up to 12 months of continuous eligibility, according to health officials.
As news of Utah's waiver approval spread, national Medicaid experts weighed in, slamming Utah leaders for attempting to place enrollment caps and creating more red tape for an already complex system.
"First of all, Utah has rejected the enhanced match, so it's actually paying more to cover fewer people," said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for low-income people.
Solomon noted that the judge that ruled in the Arkansas and Kentucky case determined Medicaid programming is not a "buffet" and states "can't pick and choose what they want to do." Enrollment caps, she said, create inequities and could deny otherwise eligible people coverage just because of the timing of their application.
"This waiver fundamentally ignores the very roll Medicaid was designed to play," Solomon said, adding that people who fall on hard times or lose their jobs "shouldn't be arbitrarily denied coverage just because of the day they apply."
But Utah leaders say SB96 balances health care coverage and a way to protect Utah's budget from unknown costs.8 comments on this story
“We have been working on Medicaid expansion for many years in our state," Rep. Jim Dunnigan, who was the House sponsor of SB96, said. "This approval builds on the work we have done in previous years to cover parents, the homeless and those involved in the justice system. It is exciting to see the state’s work come to fruition and for us to begin covering all of the adults who are in the coverage gap.”
Sen. Allen Christensen, R-North Ogden, who sponsored SB96, applauded the Centers for Medicare and Medicaid Service for approving the waiver and said "we look forward to working with them" on the other request.
To be eligible for the new program, individuals must be Utah residents between the ages of 19 and 64, a U.S. citizen or legal resident, and meet income requirements.
Information on how to apply for Medicaid can be found at https://medicaid.utah.gov/apply-medicaid.