Utah Receives Approval of Key Pieces of “Fallback Plan” Waiver, Including Full Medicaid Expansion and Work Reporting Requirements
On January 1st, 60,000 Utahns Will Become Eligible for Medicaid Expansion Coverage, With Work Requirements Moving Forward

Stacy Stanford

SALT LAKE— Today, the Utah Department of Health received confirmation from the Centers for Medicare and Medicaid Services that key pieces of the state's "Fallback Plan" waiver, including full Medicaid expansion and work reporting requirements, have been approved. On January 1st, roughly 60,000 more low-income people will become eligible for Medicaid coverage . These are individuals earning up to approximately $17,000 per year, or a family of four earning up to approximately $35,000 per year. After almost nine months of paying 32% for the partial Medicaid program, the state will now being to receive the 90/10 match rate, and will be able to cover more individuals at a lesser cost.

This news comes more than a year after voters approved Proposition 3, and more than ten months after the repeal of that citizen initiative through SB96. This Fallback Plan waiver was added to SB96 after advocates fought against a full repeal of Medicaid expansion in the case of waiver denial. After the federal government rejected the state's request to receive the enhanced 90/10 match rate in exchange for a partial expansion in July, the state then submitted the Fallback plan waiver. (A reminder of the complicated contents of SB96 can be found here and here .)

Today the state also received approval to implement work reporting requirements on individuals between 100-138% FPL. The state anticipates that with this approval, plus the previous work reporting requirement approval on those between 0-100% FPL, approximately 7,500 individuals will lose coverage. A Commonwealth Fund estimate anticipates coverage losses up to 17,000. Medicaid waivers require a period of public comment at both the state and federal level; UHPP, and other advocates submitted over 4,000 comments from the public earlier this month. The overwhelming majority of those messages spoke out against work requirements. UHPP is disappointed that neither the state, nor CMS, utilized this feedback in their decision making. We will continue to voice the concerns of Utahns about these harmful changes to the Medicaid program that will inevitably result in coverage losses.
The Fallback Plan waiver included many other requests that CMS did not give guidance on at this time. This includes: housing related services, monthly premiums ($20 for an individual, $30 for a couple), financial penalties for non-emergency ER visits, lockouts for intentional program violations, waiving presumptive eligibility, and expansion of Targeted Adult Medicaid eligibility.
“Thank goodness for the fallback plan. Without it, there would be no expansion in Utah, let alone a full expansion," said Matt Slonaker, Executive Director at Utah Health Policy Project. "This has been a long time coming, though it isn’t as clean as the public wanted with the ballot initiative. The work reporting requirements are unnecessary and do nothing to promote health. We will keep fighting against that and other waiver provisions that make it harder for vulnerable Utahns to get care.”

"This full Medicaid expansion would not have been possible without the good people of Utah speaking up. Whether you told your health care story, or voted for Proposition 3, or called your elected officials, we have you to thank for tens of thousands of Utahns gaining access to care," said Stacy Stanford, UHPP Heath Policy Analyst. "The approval of work reporting requirements is an unfortunate damper on this announcement, and will provide an unnecessary bureaucratic barrier, but full expansion is an incredible step forward, and worth celebrating."
For more information contact:
Stacy Stanford, Policy Analyst
Utah Health Policy Project

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