Utah is still waiting for federal approval or denial of its Medicaid expansion plan, which would impose work requirements on patients and rely on increased federal funding to provide health care to roughly 70,000 people.
But on Friday, a federal judge ruled against Kentucky’s Medicaid program, the first in the nation requiring beneficiaries to work, volunteer, or go to school as a condition of health-care coverage.
Despite the similarities, state Rep. Robert Spendlove, R-Sandy, said he expects the Utah expansion plan he sponsored earlier this year to be approved and ultimately implemented.
The distinction between the two states, he said, is that Utah is relying on work requirements to increase the numbers of patients covered, while Kentucky sought to shrink services through its community engagement restrictions.
“I don’t know whether it will have a direct impact on what Utah is doing,” Spendlove said of the Kentucky decision, issued Friday in the U.S. District Court for the District of Columbia. “I think [Utah’s] policy is still sound.”
Courtney Bullard, education and collaborations director for the Utah Health Policy Project, said the court’s ruling is the latest indication of trouble for state plans that fall short of full, unrestricted Medicaid coverage under the Affordable Care Act, also known as Obamacare.
If Utah’s plan is approved by federal health care officials, Bullard said, it will likely face its own court challenge.
“The purpose of Medicaid is to give access to care,” she said. “It has nothing to do with work.”
Under Obamacare, states have the option of expanding Medicaid to fill what has become known as the “coverage gap,” or the patients and able-bodied adults who have incomes too high to qualify under previous Medicaid requirements but who make too little to receive insurance subsidies.
Federal law anticipates 90 percent of Medicaid costs being paid for with federal funding, with 10 percent coming from state budgets, in order to provide coverage to individuals and families who earn up to 138 percent of the federal poverty line.
Utah currently has a 70-30 split with the federal government, and the new plan anticipates moving to the 90-10 structure while accepting beneficiaries who earn up to 100 percent of the poverty line. That amount is $12,140 for a single person or $25,100 for a family of four.
“The goal of our proposal all along has been to expand coverage and to cover more people,” Spendlove said. “[The Trump Administration’s] response was positive, but they do have to go through an official, legal process. They’re going through that process now.”
But Utahns are facing a competing, more ambitious expansion plan in the form of a ballot initiative, which has qualified for a public vote in November. If approved, the initiative would result in a full expansion of Medicaid (covering those up to 138 percent of poverty level) in the state, combined with a 0.15 percent sales tax increase, to close Utah’s coverage gap.
“We have 150,000 Utahns right now in the coverage gap,” Bullard said, “and they need care.”
A recent Salt Lake Tribune-Hinckley Institute of Politics poll showed a majority of Utah voters supported the initiative.
The federal Center for Medicare and Medicaid Services, or CMS, has shown skepticism toward some states’ partial expansion plans. Bullard said the failure of Kentucky, Massachusetts and Arkansas to implement their policy proposals suggests Utah’s plan will either be denied, be overturned in court, or be superseded by voters in November.
“We’re waiting for a [waiver] approval and it’s looking, with every other decision that we see, less and less likely,” she said.
After Friday’s court decision, Kentucky Gov. Matt Bevin announced that dental and vision coverage would be cut for roughly 500,000 Medicaid patients in an effort to trim costs, according to the Associated Press.
Tom Hudachko, a spokesman for the Utah Department of Health, said the department will monitor CMS’ response to the court ruling, and is prepared to modify Utah’s waiver request if the federal government issues new guidance.
“We remain committed to the concept of providing a path to self-sufficiency through the work requirements,” Hudachko said.
The proposed work requirements apply only to able-bodied adults within the expansion group, Hudachko said, most of whom do not have dependent children. Those rules are closely aligned with other federal programs like the Supplemental Nutrition Assistance Program, or food stamps, and Temporary Assistance for Needy Families.
“Utah will waive loss-of-eligibility penalties if individuals can demonstrate good cause for failure to participate,” he said.
Spendlove said the state needs to provide health care for the needy without offering benefits that are so abundant that they discourage people from working.
He said he has studied the ballot initiative and plans to vote against it, because it would place an unsustainable burden on the state’s resources.
“Even with the tax increase, our costs are going to outrun our revenues,” he said.