A majority of Utah voters approved Proposition 3 this month, meaning the Medicaid expansion initiative will take legal effect in December.

But the actual deadline for the state to have an operational, fully expanded program is April 1, giving the Utah Department of Health and Medicaid administrators a tight deadline to prepare for an influx of tens of thousands of enrollees.

“That’s a really tight time frame for us,” said Nathan Checketts, the state’s Medicaid director. “There are a lot of operational lifts we have to get done to hit that.”

Checketts said the Utah Department of Health kept tabs on polling, which showed Proposition 3 carrying majority support ahead of the election. And some preliminary steps were taken before the vote, Checketts said, to put the program in a position to begin expansion if and when the initiative succeeded.

“We directed our operational teams to do some prep work before the vote happened,” he said.

Under Prop 3, Utah’s sales tax on nonfood items will increase by 0.15 percentage points. That change will generate roughly $90 million in new state revenue, which will be combined with $800 million from the federal government to provide health care coverage to an estimated 150,000 low-income Utahns.

Once the expansion is in place, effectively any Utahn with an income at or below 138 percent of the federal poverty level — and who is a U.S. citizen or legal resident — will qualify for enrollment in Medicaid.

“We need to get new staff in [place] to cover the dramatic increase that this is going to be,” Checketts said. “We’ve done the background work, and we believe we have the right things lined up so we can be able to start April 1.”

Matt Slonaker, executive director of the Utah Health Policy Project, or UHPP, said he, too, is optimistic that the state will be positioned to enroll new beneficiaries in April. That also means opening the application process in March or February.

“We’re kind of trying to urge things along as much as possible,” Slonaker said. “People have been waiting for this for a very long time — waiting for a benefit to be able to address their health care needs.”

The Affordable Care Act, or Obamacare, originally intended for Medicaid expansion to be automatic. But a U.S. Supreme Court ruling gave states the option of expanding or maintaining their programs.

In Utah, various expansion plans were proposed and defeated by the Legislature — including Gov. Gary Herbert’s “Healthy Utah” plan — before a partial expansion bill that imposed work requirements on beneficiaries was approved earlier this year. That plan had not been approved by the federal government and is now superseded by the public vote on Prop 3.

By not fully expanding Medicaid until now, Utah and other nonexpansion states faced what has become known as “the coverage gap.” Because Obamacare assumed expansion would cover low-income households, some low-income individuals found themselves earning too much money to qualify for traditional Medicaid but not enough money to buy health insurance.

Randal Serr, director of Take Care Utah, a program within UHPP that helps people sign up for health insurance, said his organization received so many calls after the adoption of Obamacare and in the years since that he expects people in the coverage gap know about, or can be made aware of, Medicaid expansion in the state.

“For better or worse, we got really good at explaining what the Medicaid gap was," he said. “We’re confident that we can get the word out.”

Serr said community groups like Take Care Utah will be working to enroll as many people as they can in Medicaid. Full enrollment won’t happen overnight, he said, but over time low-income Utahns will be able to get the help they need.

“It’s going to take probably a year or two to get everybody signed up,” he said. “Once people start hearing about it, word just spreads like wildfire.”

But the more people enroll in Medicaid, the greater the cost faced by the state. Backers of Prop 3 believe the initiative’s structure of a sales tax and matching federal funds will generate sufficient revenue in the short term but acknowledge there are many unknowns down the line.

Checketts said one advantage of waiting to expand Medicaid is that Utah can learn from the experience of other states. Many states have exceeded their enrollment estimates, Checketts said, which strained budgets and health care systems.

“We would hope our estimates are better," he said, “because we were able to look at their experience.”

Fear of runaway costs led several Utah lawmakers to vocally oppose Prop 3, and it was the primary sticking point in debates over previous expansion plans in the Legislature.

Before Election Day, one state senator said he intended to run a repeal bill if the initiative succeeded. He later said a full repeal would likely not be “palatable.”

During his November KUED news conference, Gov. Herbert suggested that changes may need to be made to Prop 3 to protect the influx of new Medicaid beneficiaries from overburdening state coffers.

“Democrats and Republicans alike have called Medicaid the budget buster of all time,” Herbert said. “The question is affordability and fiscal responsibility going forward.”

Slonaker said he’s open to amendments that would strengthen or improve the Medicaid program but would push back on any effort to delay or limit enrollment.

He noted that out of three initiatives that qualified for this year’s ballot, Prop 3 achieved the widest margin of victory.

“The people have spoken,” Slonaker said.

He added that after years of debate over Medicaid, there is likely some relief that the topic is — for now — settled.

“Medicaid expansion has sucked the oxygen out of several legislative sessions,” Slonaker said. “I think most legislators are going to be pretty happy to go back to the other issues.”