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SALT LAKE CITY — The public is getting an opportunity to weigh in this month on the most significant federal waiver needed for the partial Medicaid expansion program put in place earlier this year by the Utah Legislature.
"We're talking about the big one," said Sen. Allen Christensen, R-North Ogden, sponsor of SB96, the legislation that replaced the full Medicaid expansion approved by Utah voters last November.
Christensen said he remains "very optimistic" that the state's latest waiver request will be granted by federal officials because it includes a cap on federal spending that "becomes a ceiling on their risk and responsibility."
He said that should ease the way for approval of the other key part of the waiver, a higher federal-to-state funding match even though Utah's Medicaid program leaves out tens of thousands of people who would qualify for full expansion.
But supporters of full Medicaid expansion say there's little reason to believe Washington will make an exception for Utah when it comes to a program created as part of the Affordable Care Act.
None of what Utah is asking for has been approved in other states, said Stacy Stanford, a policy analyst with the Utah Health Policy Project. "And we don't see anything in this latest waiver that makes us think that will change."
Stanford said even if the waiver does go through, it would face a legal challenge.
"None of that tricky math and the balancing act, none of that would be necessary if we just accepted traditional Medicaid expansion," she said. "This is the state doing backflips to avoid just expanding the traditional, fiscally responsible way."
Before the latest waiver can be submitted to the federal government, the state is required to seek public comment.
Two public hearings will be held in Salt Lake City, on Thursday from 2 p.m. to 4 p.m. in room 125 of the Cannon Health Building, 288 N. 1460 West; and on June 17, from 4 p.m. to 6 p.m. in the Multi Agency State Office Building, 195 N. 1950 West.
Utahns can also turn in comments to the Utah Department of Health through June 30, either online, at medicaid.utah.gov/1115-waiver, or by email, at email@example.com.
The federal government has already allowed the state to start a modified version of Medicaid expansion on April 1 at a lower federal-to-state funding match, 70 percent to 30 percent, than offered for full expansion.
Now, Utah officials are getting ready to asking Washington to provide the same 90 percent to 10 percent match as full expansion for covering fewer people with even more restrictions, while agreeing to the per-capita spending cap.
Unlike full expansion, which covers anyone earning up to 138 percent of the nearly $12,500 federal poverty rate, the state's partial expansion program is only available to Utahns earning up to 100 percent of that rate.
The so-called bridge program that's currently in place includes a work requirement for participants and an enrollment cap that are not part of full expansion, restrictions the state has agreed not to implement until next year.
Tom Hudachko, Utah Health Department spokesman, said just over 31,000 people have enrolled in the bridge program, a number that includes about 17,000 previously covered through other programs.
Between 70,000 and 90,000 qualify for partial Medicaid expansion, out of the 150,000 estimated to be eligible for full expansion. Hudachko said the department did not envision everyone able to receive Medicaid would sign up right away.
He said the funding cap in the latest waiver is based on average monthly health care costs for program participants of $649 for parents, $755 for homeless adults who have already been receiving Medicaid and $1,761 for adults without dependents.
Whether Utah exceeds the per-capita cap on spending for the partial expansion program would not be reconciled for five years under the state's proposal, Hudachko said, calling it a demonstration project that could be adjusted.
Should the federal government not approve the latest waiver by the end of the year, SB96 contains a fallback plan that would expand coverage to the full expansion population while keeping the work requirement and dropping the enrollment cap.
And if that fallback plan fails to win federal approval by July 1, 2020, the state would adopt full Medicaid expansion as approved by voters under a compromise reached over SB96 amid protests.