Feds sign off on Utah’s partial Medicaid expansion ‘bridge’ plan to clear way for enrollment beginning Monday

(Al Hartmann | Tribune file photo) The Utah Health Policy Project, hundreds of citizens and advocates of the governor's plan to expand Medicaid attend a rally on March 5, 2015.

Between 70,000 and 90,000 Utahns are clear to enroll in Medicaid on Monday after federal administrators on Friday approved the state’s partial expansion plan.

The Utah Department of Health confirmed on Twitter that Utah’s initial “bridge” waiver had been granted by the Centers for Medicare and Medicaid Services (CMS), teeing up a temporary expansion program that will allow individuals earning up to 100 percent of the federal poverty limit to enroll in Medicaid. The federal government will cover 70 percent of the costs.

“It’s a great opportunity for individuals that are uninsured and below the poverty level,” said Nathan Checketts, the state’s Medicaid director. “If they have applied before and were denied because that group wasn’t eligible, we hope they will come back and apply.”

The bridge program is expected to last for up to a year but eventually be replaced by a permanent Medicaid program that, if approved, would see the federal government increase its share of costs to 90 percent. In exchange, Utah will request additional waivers to impose work requirements, per-capita spending caps and other cost control measures on beneficiaries.

“We hope to have that [request] submitted within the next month or so,” said Tom Hudachko, spokesman for the Utah Department of Health.

While the bridge program that begins Monday also includes work requirements, Hudachko said those elements will not be enforced.

“It does include elements like the self-sufficiency requirement and the requirement, where it’s available, that people enroll in their employer-sponsored health insurance plan,” Hudachko said. “Neither of those things will be implemented until January of next year.”

Both the “bridge” and eventual permanent expansion plans leave roughly 50,000 low-income Utahns off the Medicaid rolls who would otherwise be covered by full expansion under the Affordable Care Act. In November, voters approved the full-expansion Proposition 3, but lawmakers rejected the initiative in favor of their own program, citing the need to control costs.

The shift in policy means that Utah will initially be spending more taxpayer dollars to provide health care to fewer people than it would have under the ballot initiative.

Medicaid work requirements in other states have been struck down in court, and CMS has never yet approved the types of caps and cost-splitting arrangements that will be requested by Utah.

“We know that as we go for the per-capita cap, we’re introducing some new concepts there,” Checketts said. “We think they’re good for the state and for the federal government, but it would be the first that some of these things have been requested.”

Critics of Utah’s partial-expansion plan say they anticipate legal challenges to the state’s Medicaid program, if it is approved. A successful challenge could trigger a fallback provision in the state’s law that would see full expansion, similar to Proposition 3, take effect.

Checketts said Utah’s work requirements differ from those in states like Arkansas and Kentucky, which were rejected this week by a federal judge. He acknowledged the possibility of a lawsuit against Utah’s program, while adding it’s unclear how, or if, those court precedents would be applied in such a case.

“We’ll have to see if that happens,” Checketts said. “This has been a state-by-state issue.”

Randall Serr, director of the enrollment-assistance organization Take Care Utah, said he was “elated” that Utahns in the Medicaid coverage gap would now be able to access health care.

“We’re really excited that we don’t have to tell people repeatedly calling our office wanting health insurance that they don’t have an option,” Serr said.

And while there is still some uncertainty around the long-term status of Medicaid in Utah, Serr said he expects tens of thousands of new enrollees to demonstrate the need for the program, and to positively impact the state’s health care systems.

“It’s going to stabilize the health insurance market,” Serr said. “It’s going to make it so there’s less people going to the emergency room. There’s going to be a lot of benefits that I think everyone will see once it’s in place.”

Taylorsville Republican Rep. Jim Dunnigan, House sponsor for the Prop 3-replacing SB96, said he was pleased the state’s “bridge” waiver had been approved.

Asked about the recent court rulings, Dunnigan said Utah lawmakers intentionally avoided a strict requirement that beneficiaries be employed. Instead, he said, Utah’s law requires a work “effort,” which includes education, professional training or job searches, and provides exceptions to parents and individuals with mental or physical health impairments.

“Those who are able-bodied, they will have to make some effort to get training or eduction,” he said. “It is absolutely not a requirement, like some other states have done.”

Dunnigan said the state’s next set of waivers are “cutting edge" but that CMS representatives have expressed interest in considering Utah’s plans. He said final approval of the permanent program could take some time but that he doesn’t have any reason to expect its rejection by federal administrators.

“We worked on this for a long time,” Dunnigan said. “I’m very excited that Monday, people can start enrolling.”