Utah submits small-scale Medicaid expansion plan to feds — again

The new plan would implement work requirements, lifetime limits for certain groups covered by Medicaid<br>

(Chris Detrick | Tribune file photo) Utahns for the Medicaid Expansion, faith leaders, nurses association members and members of the public participate during a 2013 rally at the State Capitol. Late Tuesday, state officials submitted their most recent proposal for expanding Medicaid coverage, this time to about 6,000 of the state's neediest childless adults.

The fate of Utah’s Medicaid expansion plan extending coverage to about 6,000 of the state’s neediest childless adults is now in the hands of the Trump administration.

Utah officials submitted the plan, which would cover childless adults who are chronically homeless or in need of mental health or drug addiction treatment, late Tuesday night. And they hope it gets approved in time to begin enrolling Jan. 1, 2018.

This is Utah’s second attempt to expand health coverage to this population after the Utah Legislature last year passed — and Gov. Gary Herbert signed — a small-scale plan. That proposal still awaits federal approval more than six months past when state officials had hoped to begin enrolling individuals, on Jan. 1, 2017.

So, state officials opted to modify their Medicaid proposal instead, adding work requirements and other limits that had previously been nonstarters under President Barack Obama’s administration.

State health department officials received more than 230 public comments on the details of their Medicaid expansion proposal.

The next step is for the Centers for Medicare and Medicaid Services (CMS) to hold its own public comment period on the proposal.

“We are hopeful that CMS will approve,” said Kolbi Young, spokeswoman for the state health department, “but we will not know until we receive their determination.”

Utah’s proposed Medicaid changes include:

  • An overall cap on enrollees for the newly added categories at 25,000.

  • A 60-month lifetime limit on coverage under Medicaid and the state’s Primary Care Network for those new enrollees.

  • A requirement that beneficiaries of the Primary Care Network, a Utah program that offers fewer benefits than Medicaid, either work 30 or more hours per week; seek employment; or participate in training unless they qualify for a half-dozen exemptions. That requirement has the potential to be expanded to childless adults Medicaid recipients “at a later date,” the plan states.

  • A $25 copayment for nonemergency visits by a individuals currently on Medicaid to an emergency room. This would not apply to the three targeted groups.

State officials began enrolling between 3,000 and 5,000 low-income parents in a separate, already approved plan on July 1.  About 2,500 of those parents are currently on the Primary Care Network plan and have already been identified for a shift to the more comprehensive Medicaid coverage.