Blog Post

Insight: Utah’s Expanding Medicaid Coverage

By: Laura Summers, M.P.P.

One thing I’ve learned from my time working on state health care reform is that Medicaid is a very important, but very complicated program. At the most basic level, it is known for providing health care coverage to low-income children, pregnant women, parents with dependent children, seniors, and people with disabilities. It also helps pay for long-term medical care such as nursing home stays, which Medicare generally does not cover.

But digging deeper, one finds that Medicaid is comprised of a myriad of different programs, benefit packages, and eligibility criteria—particularly for adults.

While these programs are designed to best meet the needs of different groups of adults eligible for Medicaid, they are limited in who and, sometimes, what they cover. As a result, there is a segment of adults in Utah who fall in the “coverage gap,” meaning they make too much money to qualify for Medicaid, but not enough money to qualify for federal tax credits that help them purchase health insurance on HealthCare.gov.

After years of debating whether and how to address this coverage gap, Utah is poised to move forward with one of three changes to its Medicaid program in 2019.

  1. B. 472: Medicaid Waiver Expansion (2018 General Session)

This program expands Medicaid to 70,000‒90,000 adults with income up to 100 percent of the federal poverty level (FPL). This equates to an annual income up to $12,140 ($25,100 for a family of four). The state will impose a tax on hospitals to pay for the expanded coverage.

Utah recently submitted a waiver application to the federal government requesting approval for this program because it differs from what is allowed under federal Medicaid rules. Utah is asking the federal government to pay an enhanced portion of the costs of providing care to the adult expansion population, allow a work requirement as a condition of eligibility (exemptions exist), allow caps on enrollment, and require adults to enroll in qualifying employer-sponsored insurance (ESI) when available. It is uncle