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SALT LAKE CITY — Utah's "bridge" program to expand Medicaid to about 70,000 to 90,000 adult Utahns got federal approval Monday — meaning eligible adults can apply starting Friday.
That's according to the Utah Department of Health, which issued the announcement Friday.
The Centers for Medicare and Medicaid Service approval of Utah's program comes after the Utah Legislature passed earlier this year a replacement to the voter-approved Proposition 3, which would have fully expanded Medicaid.
Instead, Utah lawmakers passed a more limited plan, extending Medicaid coverage for Utahns earning only up to 100 percent of the approximately $12,000 federal poverty rate — not up to 138 percent covered under the full expansion in Proposition 3.
Leading up to lawmakers' passage of the plan, SB96, critics questioned whether the federal government would approve the waivers needed for Utah's plan, while lawmakers said they had been given indications that the waivers would be approved. Approval for the first part of Utah's program came Friday.
“It isn’t easy to design a program that cares for the whole needs of a person, including the social determinants that we know have such a large impact on health like work and community engagement,” said Seema Verma, Centers for Medicare and Medicaid Service administrator in a news release.
“Gov. (Gary) Herbert and his team have shown tremendous leadership by developing a sustainable Utah solution that extends coverage while helping to lift families from poverty instead of trapping them in public assistance.”
Under the newly approved plan, Utah residents who earn up to 100 percent of the federal poverty level — about $12,492 for an individual or $25,752 for a family of four — will be eligible to receive full Medicaid benefits, according to the Utah Department of Health. The federal government will cover approximately 70 percent of the cost of the new program while the state of Utah will cover the remaining 30 percent.
“This is an important first step in covering vulnerable Utahns in a financially sustainable way,” Herbert said in a prepared statement. “But it’s just a first step. In the coming months, we will submit a detailed proposal seeking a new funding arrangement with CMS that will decrease the state’s share of the costs, provide the federal government with assurances on its costs, and provide the state with additional flexibility to manage the program.”
House Speaker Brad Wilson, R-Kaysville, was out of town Friday, but his spokesman, Matt Lusty, told the Deseret News "he's very excited" about the approval.
"This is an important step as we expand Medicaid and make sure that we take care of the most vulnerable among us in society," he said. "We need to do so in a way that protects the state budget, and this is the first and most important step."
Friday's approval paves the way for Monday's partial expansion, known as a "bridge" plan, a temporary plan to expand Medicaid to Utahns earning below 100 percent of the federal poverty level.
SB96 initially provides a federal-to-state funding match of 70 percent to 30 percent while needed waivers are sought from Washington for the higher 90-10 match available under full Medicaid expansion.
Friday's federal approval also allows the state to cap enrollment in the program if there are insufficient state funds available to match the federal funds. It also includes authorization to implement a self-sufficiency requirement and to require eligible individuals to enroll in their employer-sponsored insurance plans, if available. However, these two requirements will not be implemented until January 2020, according to the Utah Department of Health.
Gov. Herbert signs Prop. 3 Medicaid expansion replacement into law
The GOP leadership-backed replacement for the voter-approved full Medicaid expansion ballot initiative easily cleared its final legislative hurdle Monday and was signed into law by Gov. Gary Herbert a few hours later.Utah's alternative Medicaid expansion plan imposes certain requirements on enrollees, requiring different terms from the Affordable Care Act.
Days ago, a federal judge struck down Medicaid work requirements in Kentucky and Arkansas, leading critics to ponder the possibility of whether Utah's program could be legally challenged.
Tom Hudachko, spokesman for the Utah Department of Health, told the Deseret News in an interview earlier Friday that that portion of Utah's program isn't expected to be rolled out until Jan. 1, 2020, so Friday's approval likely won't be affected by the court case.
Whether it will in the future remains to be seen, Hudachko said, though he noted Utah's work requirements are quite different than those challenged in other states.
While those states require people to be employed and work a number of hours every month, Utah has exemptions that can allow people who aren't employed to still be covered, they just need to complete certain requirements to be eligible, including an online assessment, online training programs and at least 48 job searches within the first three months.
Later this spring, the Utah Department of Health will submit a second request to the Centers for Medicare and Medicaid Service. The new request will seek to increase the federal share of the cost of the program to 90 percent and will include additional provisions such as a cap on federal funding, the ability to provide housing supports, and allowing up to 12 months of continuous eligibility, according to health officials.
“We have been working on Medicaid expansion for many years in our state," Rep. Jim Dunnigan, who was the House sponsor of SB96, said. This approval builds on the work we have done in previous years to cover parents, the homeless, and those involved in the justice system. It is exciting to see the state’s work come to fruition and for us to begin covering all of the adults who are in the coverage gap.”
Sen. Allen Christensen, R-North Ogden, who sponsored SB96, applauded the Centers for Medicare and Medicaid Service for approving the waiver and said "we look forward to working with them" on the other request.
To be eligible for the new program, individuals must be a Utah resident between the ages of 19 and 64, be a U.S. citizen or legal resident, and meet income requirements.
Information on how to apply for Medicaid can be found at https://medicaid.utah.gov/apply-medicaid.
