Lawmakers say feds may give state more flexibility on Medicaid expansion



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SALT LAKE CITY — It's going to be at least another week before lawmakers agree on a plan for Medicaid expansion, now that House Republicans have decided to hold off discussing the issue at their caucus meetings Tuesday and Thursday.

"We have gotten some information from the federal government that allows more latitude, more flexibility for the states than they told us even six months ago," said House Majority Leader Jim Dunnigan, R-Taylorsville.

GOP senators will still meet Tuesday in a closed caucus to talk about two Medicaid expansion bills sponsored by Sens. Allen Christensen, R-North Ogden, and Brian Shiozawa, R-Cottonwood Heights.

But Dunnigan said House GOP leaders want time to look at decisions made in the past few weeks by the Obama administration that allow other states to put limits on Medicaid expansion not in Gov. Gary Herbert's Healthy Utah plan.

Those limits include the ability to cap enrollment or expenditures, reject participants who don't pay their premiums and cover only the most medically vulnerable residents who earn below the federal poverty level, Dunnigan said.

Although the governor spent much of last year negotiating with Washington over his Healthy Utah plan, state lawmakers have started their own talks with the federal government to see if a more restricted plan is possible.

House Speaker Greg Hughes, R-Draper, said there are lawmakers who'd just as soon not take any action this session on the Medicaid expansion available under President Barack Obama's signature health care reform act.

What Hughes called a "wait and see argument," to wait even longer to see what the federal government may eventually allow states to do, has already been adopted by Tennessee and Wyoming and could happen in Utah.

"There is a strong sentiment that that is the best way forward. I happen to think, and I think this leadership team believes, we can and should do something," the speaker said. "We're trying to get there. But there is opposition on both sides."

In the Senate, Shiozawa's called his proposal "consistent" with the governor's Healthy Utah plan, covering Utahns making less than 138 percent of the federal poverty level.

Christensen described his measure a less expensive alternative to Healthy Utah because it limits coverage to only the medically frail earning less than 100 percent of the federal poverty level.

"We'll debate the merits of each of those," said Senate President Wayne Niederhauser, R-Sandy. "It's hard to predict what the outcome will be after that."

Last week, House Republicans pitched a joint caucus meeting with Senate Republicans. But Niederhauser said the Senate GOP wants to caucus before talking about meeting with House.

Hughes said he still has "high hopes" for a joint caucus. Because Republicans hold supermajorities in both the House and Senate, the likely closed-door caucus could determine the fate of Medicaid expansion this session.

The governor's spokesman, Marty Carpenter, said Healthy Utah is still the best deal the state can get from Washington because "it covers the most people at the lowest cost per person covered" and brings back the most federal dollars.

Consensus numbers released by the governor's office show that over six years, Healthy Utah would cover 146,000 people, nine times as many as the next best option, at a cost of $236 million.

Because the governor's plan covers Utahns earning up to 138 percent of the federal poverty level, the federal government would pick up 90 percent of the cost, $3.2 billion or $13 for each $1 spent.

That compares with a $200 million price tag and $611 million from the federal government for Christensen's plan, or $3 for every $1 spent because only 70 percent of the cost is picked up by Washington since coverage is limited.

"We're always looking for ways to improve the plan," Carpenter said. But, he said, just because another state received a particular concession doesn't mean that would be available to Utah.

"We've been able to receive significant concessions from the federal government," Carpenter said. "I think the governor is always interested in seeing we get the best deal."

Contributing: Dennis Romboy Email: lroche@ksl.com Twitter: DNewsPolitics

Lisa Riley Roche

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