While the federal government provides increasingly larger slices of the budget pie in most states, Utah is an exception, according to a new study by the Pew Charitable Trusts.
And Utah legislators’ refusal to fully expand Medicaid for low-income people is a key reason why, it says. Utah voters will decide themselves whether to approve full Medicaid expansion through an initiative that will appear as Proposition 3 on the Nov. 6 ballot.
The federal government provided 25.7 percent of state revenue in Utah in 2016 to pay for public services such as health care, education, transportation and new facilities, the study reported this week, using data from the U.S. Census Bureau.
That ranked Utah 46 among the 50 states, and its share was much lower than the 32.6 percent average among all states.
The federal government provided budget pie slices in some states that were nearly 70 percent larger than in Utah.
For example, Mississippi received 43.3 percent of its budget from the federal government; Louisiana received 42.7 percent; and Arizona and New Mexico both received 41.2 percent.
The slice received by Utah decreased by 1.1 percentage points compared to 2015, the study said — which was tied for the third biggest drop among the states.
That came as the overall share of state revenues from the federal government increased for the third year in a row, and reached the third-highest on record.
The study said 30 out of the 50 states saw gains in federal dollars as a share of state revenue that year, and “20 were Medicaid expansion states.” It noted that Medicaid alone accounts for two-thirds of federal grants to states.
In 2016, many states that chose to fully expand the federal-state Medicaid program began to receive enhanced federal aid through the Affordable Care Act. Nationally, enrollment in Medicaid increased 3.8 percent that year.
But Utah legislators have repeatedly rejected full expansion of Medicaid — arguing that the full federal reimbursement to cover those costs could disappear over time and leave the state responsible for an expensive program.
The Legislature’s stance led to a ballot initiative by Utah Decides Health Care, which will give voters the decision this year on whether to fully expand Medicaid to cover 150,000 more low-income Utahns.
Possibly to short-circuit that initiative, the Legislature this year passed an alternative that would cover about 72,000 people instead — with a strict work requirement for able-bodied recipients — if the state is able to work out waivers to federal rules.
Under that proposed plan, the federal government would pay 90 percent of the costs, and the state would pay 10 percent.
That plan passed by the Legislature would cover only those who earn up to 100 percent of the poverty line, which this year is $12,140 for a single person or $25,100 for a family of four. Full expansion would cover people who earn up to 138 percent of the poverty level.