Utah submits ‘fallback’ Medicaid waiver for public comment

Utah released for public comment its “fallback” Medicaid waiver, which would expand coverage to those who make up to 138% of the poverty level, with some requirements. | Adobe Stock

Waiver would expand Medicaid coverage to those making between 100% and 138% of the federal poverty level

SALT LAKE CITY — Utah released for public comment its “fallback” Medicaid waiver, which would expand coverage to those who make up to 138% of the poverty level, with some requirements.

“This waiver is finally a move toward the full Medicaid expansion supported by Utahns for more than five years, and passed by voters in 2018. The delay has cost the state millions of dollars, and has cost too many Utahns their lives,” said Stacy Stanford, policy analyst for advocate group Utah Health Policy Project, in a news release Monday.

Last week, Stanford’s group said not fully expanding the program is costing the state $6.6 million extra a month while the state pays 30% instead of 10%, as it would under full Medicaid expansion under the Affordable Care Act. The state disputed that number, saying it instead is costing $2.5 million extra.

“While we celebrate this progress, we also fight against harmful red tape and cost-sharing barriers. Full expansion, with no strings attached, is still the best option for Utah,” Stanford said.

Utah had been trying to “expedite” the process of preparing the fallback waiver, which is required by state law to be submitted to the Centers for Medicare and Medicaid Services by March 15, 2020, according to the health department.

The Utah Department of Health began accepting comments on the fallback waiver on Friday and will continue through Oct. 27.

Utah has been in a holding pattern since it received an informal rejection from the federal government on waivers under its limited plan that covers adults up to 100% of the federal poverty level with a self-sufficiency requirement and per-capita cap.

Utah sought a federal 90% funding match from the federal government, but the Centers for Medicare and Medicaid Services said it would deny waivers from states that were allowing fewer people to be enrolled than required by the Affordable Care Act.

Kolbi Young, spokeswoman for the state Medicaid program, said the program has not received a formal denial from the federal government yet.

“The intention was that if there was no action or no decision, that we would still be moving forward and trying to implement Medicaid expansion here, without having to have that approval,” Young said.

The fallback plan would cover those making up to 133% of the poverty level but would include a self-sufficiency requirement, and require enrollment in an employer’s plan with premium reimbursement when offered.

According to expansion bill SB96 — passed as an alternative to full expansion called for by voters under Proposition 3 — the state has to work through a couple of options before Medicaid would be fully expanded. If those proposals are not approved by U.S. Centers for Medicare and Medicaid Services by July 1, 2020, the health department must then institute full expansion in Utah, increasing eligibility to those making between 100% and 138% of the federal poverty level under the Affordable Care Act.

People can comment on the fallback waiver during two public meetings. The first will be held from 4 to 6 p.m. on Monday, Oct. 7, in Room 1020C at the Multi-Agency State Office Building, 195 N. 1950 West in Salt Lake City. The second will take place from 2 to 4 p.m. on Thursday, Oct. 10, in Room 125 at the Cannon Health Building, 288 N. 1460 West in Salt Lake City.

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