Blog Post

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 unclear whether the federal government can or will approve some of the provisions included H.B. 472.

2. 2018 Ballot Initiative (Utah Decides Healthcare Act of 2018; Proposition #3)

This program expands Medicaid to 100,000‒150,000 adults with income up to 138 percent FPL. This equates to an annual income up to $16,753 ($34,638 for a family of four).

Unlike H.B. 472, Utah voters have a say in the implementation of this program as the Utah Decides Healthcare Act of 2018 will be included on the November 2018 general election ballot. The Act includes a 0.15 percentage point increase in the sales tax rate (i.e., 4.7 to 4.85 percent) to pay for the expanded coverage.

3. B. 325: Enhancement Waiver Program (2018 General Session)

This program does not address Utah’s coverage gap, but will likely be the default scenario if H.B. 472 is not approved by the federal government and the Utah Decides Healthcare Act does not pass in November. The program would provide enhanced medical benefits for 13,800 Medicaid enrollees with a limited benefit package and reduce medical benefits for about 10,200 Medicaid enrollees with a full benefit package. The state will leverage an existing hospital tax to help pay for the extra benefits.

Medicaid is complex, but it is important for Utah voters to understand given they will have a chance to weigh in on changes made to the program this coming November. These changes will impact the state’s health care coverage program into the future.

To help Utah voters and policy makers better understand the Medicaid scenarios currently under consideration, a new policy brief by the Gardner Policy Institute provides detailed information on the proposed program changes.

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