Utah is ready to ‘flip the switch’ on Medicaid expansion next week despite not yet getting a federal waiver

Utah is days away from Monday’s scheduled partial expansion of Medicaid, despite the state not having yet received permission from the federal government to move forward with its plans.

Tom Hudachko, spokesman for the Utah Department of Health, said Thursday that all indications suggest the waiver will be approved in time.

“We don’t require any sort of advance notice or anything like that,” Hudachko said. “We’re ready to essentially flip the switch the second we get the approval.”

Hudachko was unable to comment on contingencies if the waiver should be denied, saying only “we’ll have to cross that bridge.”

His comments came the day after a federal judge ruled against work requirements imposed on Medicaid beneficiaries in Kentucky and Arkansas, fueling speculation that similar provisions in Utah and other states ultimately will be challenged in court.

“We don’t believe that the ruling yesterday will necessarily impact the overall decision to approve or not approve our waiver here,” Hudachko said.

Monday’s expansion will launch what is known as the “bridge” plan in Utah, a temporary effort to enroll in Medicaid the individuals who earn up to 100 percent of the federal poverty line, with the expectation that the federal government will pay 70 percent of the costs.

Lawmakers committed tens of millions of public dollars to support the bridge program for up to a year, at which point a permanent program is expected to take effect with the federal government, boosting its cost share to 90 percent.

Both the short- and long-term Utah Medicaid programs impose work requirements on beneficiaries, and those require federal waivers to stray from the terms of the Affordable Care Act, or Obamacare. But Hudachko said state administrators will not enforce work requirements during the initial stage of expansion.

“It does have that element, but operationally our intention is to not implement it," he said. “Since the bridge plan is a temporary plan, it makes more sense to implement it with the permanent program.”

North Ogden Republican Sen. Allen Christensen, who sponsored Utah’s Medicaid expansion bill, SB96, said he was aware of the Health Department’s plans and agrees with its reasoning to delay implementation of work requirements.

“It amounts to so little that it’s almost not worth putting on there,” he said. “It’s the same work requirement for anyone who gets food stamps, or SNAP [benefits].”

But the permanent plan goes beyond work requirements in challenging Obamacare, requesting waivers for enrollment caps and per-capita federal funding, while setting a lower eligibility threshold than the 138 percent of poverty level established in federal law.

SB96, the Legislature’s replacement plan for the voter-approved initiative to adopt full Medicaid expansion, will leave about 50,000 low-income Utahns ineligible.

Courtney Bullard, education and collaborations director for the Utah Health Policy Project (UHPP), said it is the permanent plan — rather than the bridge plan — that is most likely to face lawsuits. Recent court rulings establish a precedent for challenging work requirements, she said, and legal questions remain for the other, unprecedented elements of Utah’s plan.

“What we’re really focused on is this next series of waivers that would have implications for Utah and around the nation,” Bullard said. “They directly work against the purpose of Medicaid, and they potentially don’t have legal standing.”

In November, Utah voters approved Proposition 3, which would have fully expanded Medicaid up to 138 percent of poverty under the terms of the Affordable Care Act. But the initiative was replaced before it could take effect by lawmakers, who cited a need to rein in the potential costs.

UHPP was among the groups that supported Proposition 3, and Bullard said she’d like to see the Centers for Medicare and Medicaid Services (CMS) reject work requirements in response to the court rulings, or for the state to abandon its work requirements.

“We would hope Utah would pull that part of the waiver,” she said.

In the event that Utah’s waivers are rejected — or struck down in court — SB96 includes a fallback provision that would ultimately implement full Medicaid expansion, largely in keeping with Proposition 3.

Asked about the court rulings and the potential for a lawsuit against SB96, Christensen declined comment.