Blog: What’s Being Said About Utah?

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Blog: What’s Being Said About Utah?

By: Laura Summers

Fall is hands-down my favorite season. The weather is cooling, the holidays are nearing, and Utah’s already-beautiful canyons become breathtaking. Fall is also when the Henry J. Kaiser Family Foundation and the National Association of Medicaid Directors release results from their annual 50-state Medicaid survey.

For those of us who track state health policy, there is nothing more exciting than accessing this holy grail of information on state Medicaid program changes and updates. The report provides an “in-depth examination” of Medicaid programs across the country, drawn from a “survey of Medicaid officials in all 50 states and the District of Columbia.”[1]

So what does the report say about Utah?

Utah is both expanding and narrowing Medicaid eligibility: The very first page of the report highlights Utah as a state “to watch” given it is one of three states that had Medicaid expansion proposals on their November 2018 ballots. As we recently learned, residents in all three of these states, Idaho, Nebraska, and Utah, voted to expand Medicaid.

Utah is also one of eight states that plans to eliminate retroactive eligibility for one or more Medicaid groups. Retroactive eligibility allows Medicaid to pay for services received by the beneficiary three-months prior to their application date if they were eligible for coverage at that time. Utah eliminated retroactive eligibility for its Primary Care Network program, which is a limited benefit health plan offered to a capped number of adults who are not traditionally eligible for Medicaid.

Utah is also one of 10 states that implemented a “narrow” Medicaid expansion. In FY2018, Utah expanded Medicaid to adults without dependent children who are: (1) chronically homeless; (2) involved in the justice system through probation, parole, or court ordered treatment needing substance abuse or mental health treatment; (3) needing substance abuse treatment or mental health treatment.

Utah plans to make information about its managed care plans more accessible. Utah is one of only two states that reported new quality initiatives in FY2019. Utah plans to develop a public facing dashboard that will provide comparison data on its Medicaid Accountable Care Organizations (ACOs). Utah’s ACOs are health plans that manage the state’s Medicaid population. Utah is also one of 12 states that reported new or expanded dental health plans.

Utah does not have any near-term plans to reform its Medicaid delivery or payment system. Utah is only one of a handful of states that did not report current or planned delivery system or payment reform initiatives in FY2018 or FY2019.

Utah added several new benefits in FY2018, but increased copayments and is planning to cut some benefits in FY2019. In 2017 Utah added three benefits to its Medicaid programs: (1) Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for beneficiaries age 13 and older;[2] (2) dental services for individuals with disabilities; and (3) residential treatment services in a qualifying institution for individuals with a substance use disorder.

Both New Mexico and Utah plan to eliminate Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) coverage for some individuals ages 19 and 20 in FY2019 if the Centers for Medicare & Medicaid Services (CMS) allow them to make the cut.[3]

Utah also reported increasing pharmacy copays from $2 to $4, changing inpatient copays from $220 per year to $75 per stay, and increasing hospital outpatient service copays ($4 per visit, up to $100 per year).[4] The changes apply to all beneficiaries except children and pregnant women.

In the past year Utah has made changes to its Medicaid program that closely align with actions taken in other states. While this report is meant to provide a national view of Medicaid program changes and updates, it provides a nice snapshot of recent activity occurring in each state. In general, Utah seems to be following the major policy and program trends occurring in other states.

Laura Summers is the senior health care analyst at the Kem C. Gardner Policy Institute. 


[1] Gifford, K. Edwards, B. Lashbrook, A. (2018 October). States Focus on Quality and Outcomes Amid Waiver Changes. Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019. Retrieved from

[2] SBRIT is used to identify alcohol and illicit drug abuse or dependence.

[3] For more information on EPSDT see

[4] Co-pay Information. (2018, April 2). Utah Department of Health. Retrieved from

2018-11-16T10:30:08+00:00November 16th, 2018|Blog, Economics and Public Policy, Health Care, Practice Areas|