Feds approve full Medicaid expansion for Utah

Utah will kick off the new year with a fully expanded Medicaid program, covering residents earning up to 138% of the poverty level, up from the current 100% cutoff for the state’s limited expansion. But it will require some adult participants to work or look for work, the Utah Health Department said.

Monday’s announcement means as many as 120,000 Utah adults who didn’t qualify for Medicaid at the beginning of 2019 will be eligible starting Jan. 1. The cutoff is at 138% of poverty, which translates to $16,753 for an individual and $34,638 for a family of four.

The Centers for Medicare and Medicaid Services (CMS) approved the expansion, along with the Utah Legislature’s requested waiver for work requirements, which has been controversial.

Some adults must participate in a self-sufficiency requirement to receive benefits. These individuals will have to complete an online job assessment and online training programs and, within the first three months of eligibility, document 48 job searches. Thirteen exemptions will be granted, including to those who are over age 60, caring for young children or a disabled family member, pregnant, physically or mentally unable to work, already working 30 hours a week or attending school.

“We estimate 70%-80% will meet one of these exemptions,” said Tom Hudachko, Health Department spokesman.

Additionally, the state will require newly eligible adults to enroll in an employer-sponsored health plan if one is available. Medicaid will then cover the individual’s monthly premium and other out-of-pocket expenses.

The nonprofit Utah Health Policy Project, which helped push through a voter-approved initiative for full Medicaid expansion, cheered Monday’s announcement but said it remains steadfastly opposed to the work requirement, which has entangled other states in court challenges.

“Work requirements essentially don’t work,” said Courtney Bullard, of the organization. “Work requirements are a paperwork barrier to the eligible population. … Most people on Medicaid who can work do work.”

Several courts have ruled against work requirements in other states, and Bullard said her group expects lawsuits “will come here, too, and we’ll support efforts to take those to court.”

CMS has not approved other parts of Utah’s waiver request, including special premiums for people making more than 100% of poverty and penalties for patients seeking treatment at emergency rooms for nonemergency ailments. The federal agency is still reviewing these waivers, which would be added to the program later if approved.

The nonprofit policy group previously submitted thousands of public comments opposing attaching these additional strings on Medicaid expansion.

“We really hope CMS listens to what Utahns have said about the other parts of this proposal and they end up rejecting them,” Bullard said.

The program now being implemented is a “fallback” contained within the legislation approved by the Legislature and governor to replace a straightforward full Medicaid expansion passed by voters in an initiative last year after several years of reluctance among state lawmakers to enact full expansion.

The state had wanted the federal government to pay 90% of the costs but only cover people up to 100% of the poverty line and the Trump administration rejected that, paying only 70% of the costs and leaving the state to pick up the rest. The limited expansion to 100% of poverty already added some 40,000 Utahns so far this year but ultimately would have barred enrollment by about 50,000 others who will now be eligible under full expansion.

The state then pressed forward with a full expansion to 138% of poverty but with some conditions Utah’s conservative lawmakers said were intended to contain costs.

“This approval is very important for our state budget so we can begin receiving the higher federal match for these services," of 90% rather than 70%, said Rep. Jim Dunnigan, R-Taylorsville, House sponsor of the Legislature’s bill replacing the voter initiative. "We look forward to working with CMS to obtain approval of the remaining components of our request so this expansion has the additional supports and cost controls we envisioned.”

Despite the failure of the Legislature’s original, limited expansion plan, House Speaker Brad Wilson, R-Kaysville, tweeted on Monday that the federal government’s approval of the fallback expansion is evidence that Utah lawmakers were right to repeal the voter-approved Proposition 3 and enact their alternative, SB96.

“The waiver will provide more Utahns with the coverage they need while saving Utah taxpayers millions of dollars in potential costs,” Wilson wrote. “We appreciate the willingness of the Centers for Medicare and Medicaid Services to work with the lawmakers in our efforts to craft a Medicaid program that meets the unique needs of our state."

Gov. Gary Herbert praised Monday’s decision, calling it "evidence states can craft viable, unique solutions to deliver critical health care services to their residents.”

In turn, CMS lauded Utah’s efforts to be creative.

“Under Governor Herbert’s exemplary leadership, his state diligently pursued innovative and sustainable solutions to improve the lives of all Utahns,” said CMS Administrator Seema Verma. “Local leaders understand how to best design programs that align with their local needs and goals, and I am committed to helping states achieve their goals.”

Under President Donald Trump, CMS has continued to approve Medicaid work requirements despite court rulings blocking them from being implemented. South Carolina’s work requirement waiver was granted Dec. 12, with Utah close on its heels.

Information on how to apply for Medicaid can be found at https://medicaid.utah.gov/apply-medicaid. Applications are accepted online, over the phone, or by mail.

Tribune reporter Benjamin Wood contributed to this article.