Utah submits full Medicaid expansion “Fallback Plan” waiver after partial expansion request was rejected

September 30, 2019

Stacy Stanford

SALT LAKE— On Friday afternoon, the Utah Department of Health submitted the "Fallback Plan" Medicaid expansion waiver. This is the third phase of SB96, the legislation which repealed and replaced Proposition 3.
In July, the federal government rejected the state's request to receive the enhanced 90/10 match rate in exchange for a partial expansion, which triggered the need to proceed with the Fallback. The third phase was added to SB96 after advocates fought against a full repeal of Medicaid expansion in the case of waiver denial. A fourth phase was also included, which would be triggered if this third phase is denied. (A reminder of the complicated contents of SB96 can be found here and here .)
This pending Fallback Plan waiver request includes a full Medicaid expansion up to 133% of the Federal Poverty Level (138% including the 5% disregard). This will expand eligibility to individuals earning up to approximately $17,000 per year, and a family of four earning up to approximately $35,000 per year. Utah would receive the 90/10 match rate, instead of the current arrangement where the state pays 32%.
The Fallback Plan waiver also includes the burdensome work reporting requirement, which would mirror the requirement already approved in the phase 1 "Bridge Plan" waiver, as well as an enrollment cap, which was preemptively denied on August 16th.
There are also problematic new efforts to pass Medicaid costs along to some low-income enrollees, including monthly premiums ($20 for an individual, $30 for a couple), and a $25 penalty for non-emergency ER visits.
Other requests in the waiver include: mandatory enrollment in employer sponsored insurance, lockouts for intentional program violations, disallowing hospital presumptive eligibility, housing supports to benefit certain groups, expansion of Targeted Adult Medicaid eligibility categories, and other changes to the Medicaid program.
  "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 Utah Health Policy Project. “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."
The state will hold two public hearings to discuss the amendment and take public comment. The first public hearing will held  on Monday, October 7, 2019 from 4:00-6:00 p.m. , in room 1020C at the Multi-Agency State Office Building, 195 N 1950 W, Salt Lake City, Utah.
The second public hearing will be held  on Thursday, October 10, 2019 from 2:00-4:00 p.m. , as part of the Medical Care Advisory Committee (MCAC). The meeting will be held in room 125 at the Cannon Health Building, 288 N 1460 W, Salt Lake City, Utah. 

The proposed application is available online at  https://medicaid.utah.gov/1115-waiver .

The public may comment on the proposed application request during the 30-day public comment period  from September 27, 2019 through October 27, 2019 .
For more information contact:

Stacy Stanford, Policy Analyst
Utah Health Policy Project

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