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Federal Officials Want More Utah Medicaid Expansion Details

By Marissa Evans, CQ Roll Call

July 27, 2016 -- Utah officials are getting closer to expanding eligibility for almost 11,000 low-income residents and will soon be soliciting more public comments on their plan.

Beehive State officials are involved in ongoing conversations with the Centers for Medicare and Medicaid Services (CMS) about the state's pending $31.2 million Medicaid expansion plan. The state is seeking a federal waiver that would allow it to cover specific populations under the joint state-federal health insurance program for the poor and disabled.

Andrea J. Casart, director of the Centers for Medicare and Medicaid Services Division of Medicaid Expansion Demonstrations, wrote to the Utah Department of Health in a July 15 letter that state officials needed to reveal more information publicly about estimates for annual enrollment and a fiscal analysis about the program. Then the state will need to re-open a public comment period.

"Once the state completes the public notice requirements discussed above, we will conduct another preliminary review to determine if the revised request is complete," Casart said.

Utah lawmakers passed a law that directs the state's Department of Health to implement a plan to cover between 9,000 to 11,000 beneficiaries who live in households with income up to 60 percent of the federal poverty line. An earlier version was originally intended to cover 16,000 people but state officials scaled back those numbers, citing fiscal constraints. 

The program as passed would include covering those who are either parents with dependent children, homeless individuals or formerly incarcerated people who have mental health and substance abuse problems. If approved by federal officials, enrollment would begin Jan. 1, 2017.

Utah hospitals would pay $13.6 million of the cost of the program while the state would shell out $17.6 million. Republican Utah Governor Gary Herbert signed the bill into law on March 25.

Traditionally, under the 2010 federal health law states can expand Medicaid eligibility to individuals with incomes up to 138 percent of the poverty level. By 2020, states will have to cover 10 percent of the cost. Thirty-one states and the District of Columbia have taken up the offer.

Republican lawmakers who control the legislature and the GOP governor had faced infighting over whether and how to expand Medicaid. During the 2015 legislative session, the Senate approved Herbert's proposed Healthy Utah plan, which would have covered 146,000 people. But Utah House members, many of whom oppose the federal health law, voted down the program in favor of the so-called Utah Cares plan. It would have cost $22 million less than the governor's plan and covered 93,000 people. The two plans couldn't be reconciled before the legislative session ended in March 2015.

In October, Herbert and five other Republican leaders from both chambers formed the "Gang of Six" to come up with a new proposal. The group came up with a different proposal that would have covered 126,500 people and appealed to Republican interests with provisions that would require beneficiaries to share in the cost of coverage. But that proposal also failed to capture enough support.

Despite the continued work since last year and the enactment of the scaled-back program, advocates are still wary of celebrating the pending expansion.

Jason Stevenson, education and communications director for the Utah Health Policy Project, said in an interview that advocates are worried about the enrollment process and how many people could be left out. Another concern for advocacy groups is the state's coverage gap, which affects 63,000 low-income people who make too much money to be in Medicaid under state guidelines although they would have qualified if the state had expanded to include people with incomes of up to 138 percent of poverty as the health law allows. Stevenson said the proposal under review would not make much of a dent to help Utahns in the gap.

The pending expansion plan "seems like an inefficient, complex approach to solving our health care problems here," Stevenson said. "There's a certain point of 'we'll take what we can get' and some advocates have done that but many people have been disappointed over what has emerged as they learn more about this proposal."

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