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    Utah set to implement watered down Medicaid expansion

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    The Centers for Medicare and Medicaid Services on Friday authorized the Utah Department of Health to expand its Medicaid program to approximately 70,000-90,000 Utah adults. The newly eligible individuals can begin applying for coverage on Monday, April 1, according to Tom Hudachko of the Utah Department of Health.

    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. The federal government will cover approximately 70 percent of the cost of the new program; the State of Utah will cover the remaining 30 percent, said Hudachko in an email.

    The percentage of Utahns the expansion would have covered was significantly reduced after lawmakers amended a voter-approved initiative in November’s election. That initiative would have provided gap coverage to people earning roughly 138 percent of the federal poverty level.

    “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 CMS Administrator Seema Verma. “Governor 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.”

    Today’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, said Hudachko.

    “This is an important first step in covering vulnerable Utahns in a financially sustainable way,” said Gov. Gary Herbert. “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.”

    Later this spring, at the direction of Senate Bill 96, sponsored by Sen. Allen Christen and Rep. Jim Dunnigan, the UDOH will submit a second request to CMS. 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.

    “We have been working on Medicaid expansion for many years in our state. This approval builds on the work we have done in previous years to cover parents, the homeless, and those involved in the justice system,” said Dunnigan. “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.”

    Christensen said, “We are very pleased with CMS’s responsiveness to this waiver request. We look forward to working with them on our per capita cap 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

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