Utah moves forward with 'limited Medicaid expansion' for up to 5K parents

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SALT LAKE CITY — Another 3,000 to 5,000 low-income Utah parents will become eligible for Medicaid under what the Utah Department of Health is calling "limited Medicaid expansion."

But approximately 6,500 childless adults who are homeless, involved in the criminal justice system, or in need of substance abuse and mental health treatment remain in limbo.

Health department spokesman Tom Hudachko said health officials, Gov. Gary Herbert and legislative leadership made the decision to split the proposal into two parts after negotiations with the federal government stalled.

Health officials still want to get childless adults covered, but it's a longer and more complicated process than expanding eligibility for parents, Hudachko said.

When it comes to childless adults, "we haven't pulled back on it yet, but there has just been no indication from (the Centers for Medicare and Medicaid Services) that they're moving anywhere on it," he said.

Utah lawmakers passed a small-scale Medicaid expansion plan last year after years of fighting. The plan was meant to expand coverage to a large swath of the "sickest of the sick" — particularly the chronically homeless — and a smaller section of low-income parents.

The architect of the plan, Rep. Jim Dunnigan, R-Taylorsville, said it's still crucial to get childless adults covered, particularly as the Utah Legislature and local governments tackle homelessness this year.

"Many of the people who are homeless have health needs and behavioral health needs,” Dunnigan said. “You have to provide treatment.”

State health officials and lawmakers have been in a holding pattern since the election.

President Donald Trump and congressional Republicans have vowed repeatedly to “repeal and replace” the Affordable Care Act, making the future of Medicaid expansion uncertain.

Georgia Rep. Tom Price, Trump’s pick to head the U.S. Department of Health and Human Services, has yet to be approved by the full Senate. If approved, Price will need time to get his deputies in place and decide what to do about the Medicaid program.

That means several states that applied for expansion waivers last year — including Utah — are still waiting to hear if they will be approved, according to Dunnigan.

"It's in the hands of the federal government,” he said. “We've done our part. … It's been up to them for months."

Trump’s first executive order on Jan. 21 directed federal officials to “provide greater flexibility to states” as it relates to the health care law, Dunnigan said.

"So it's like — approve it," he said.

Micah Vorwaller, health policy analyst at the Utah Health Policy Project, said he is glad that additional parents will be covered under the expansion but is disappointed that it was not able to go further.

The amended plan will extend the income eligibility limit for Utah parents from 45 percent of the federal poverty level to 60 percent.

Full Medicaid expansion as envisioned under the Obama administration would have raised the income eligibility limit to 138 percent of federal poverty level.

"Even though it was already just a mini-expansion, it became even smaller now. … That still leaves all those other people who just don't have any other option,” Vorwaller said.

The federal government still needs to approve the amended plan, but Hudachko said officials have indicated they would accept.

If approved, the expansion will cost around $5 million to $7 million in state general funds per year, he said. Newly eligible parents will likely be able to apply for coverage starting in July.

As for childless adults, Hudachko said officials have not yet talked to the Centers for Medicare and Medicaid Services since Trump took office.

"So we really do not have a feel for where they are," he said.