Health Reform WK-EDGE Will feds approve Utah’s lower Medicaid eligibility cap, work requirements?
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Tuesday, April 10, 2018

Will feds approve Utah’s lower Medicaid eligibility cap, work requirements?

By Anthony H. Nguyen, J.D.

Gov. Gary Herbert of Utah signed House Bill 472 (HB472) to expand Medicaid access in the state. The legislation would provide more an additional 70,000 Utahns with access to health coverage. There is uncertainty, however, on whether House Bill 472 ever takes effect, as the legislation needs CMS approval. The agency has sent mixed signals on whether it will accept Utah’s plan. Utah is one of 18 states that so far has declined to expand Medicaid under the Affordable Care Act (ACA) (P.L. 111-148). There are currently 32,000 adults aged 19-64 in the state covered by Medicaid.

HB472 and work requirements. HB472 extends coverage to those with incomes at or below the poverty line, not above it. That approach would give coverage to an estimated 72,000 people by 2020, increasing to 87,500 total people by 2024. HB472 includes an untested Medicaid provision – work requirements. The work requirements under HB472 could include holding a normal job, volunteering, vocational training or other similar activities. Many Medicaid recipients, however, would be exempt from the work requirements for health reasons. Utah also has a pending waiver request with CMS that includes pursuing these work requirements, as it needs special approval in order to impose the work requirement on enrollees (see States are pursuing novel changes with Medicaid waivers , December 14, 2017).

CMS has shown that it is receptive to the work requirement provision—part of expanding Medicaid coverage—as three such demonstration projects have been approved to date, all in states that expanded Medicaid eligibility under the ACA: Kentucky, Indiana, and Arkansas (see Are Medicaid work requirements illegal?, March 6, 2018). But there are indications that CMS will not approve of the lower eligibility cap from 138 percent of the poverty line to 100 percent—while still relying on 90 percent funding for the program from the federal government. CMS recently rejected Arkansas’ similar waiver request.

Critics argue the work requirements are meant to deny people coverage—a way to trim the total number of adults covered by Medicaid by adding more hurdles, including more paperwork. In turn, there is a competing Utah citizens’ initiative that would expand Medicaid coverage more widely than HB472 and is in the process of gathering signatures to appear on the state’s November voting ballot. The popular ballot initiative would extend Medicaid coverage to people who earn up to 138 percent of the federal poverty line, which this year was at $12,140 annually for a single person or $25,100 for a family of four. That means roughly 150,000 Utah adults would gain Medicaid coverage under the initiative proposal.

Utah litigation. HB472 is not the state’s first attempt at addressing Medicaid access for its residents. Utah also joined 19 other states in a lawsuit against the federal government challenging the constitutionality of what remains of the ACA after the Tax Cuts and Jobs Act of 2017 (P.L. 115-97) eliminated the individual mandate’s tax penalty only (see 20 states seek repeal of entire ‘unconstitutional and irrational’ ACA, February 27, 2018). In the complaint, the states argue that with no remaining legitimate basis for the ACA, the law "forces an unconstitutional and irrational regime" on the states and their citizens and must be stricken.

Legislation: StateLegislationNews NewsFeed AccessNews AgencyNews DemonstrationProjectNews EnrollmentNews MedicaidNews MedicaidExpansionNews FedTracker HealthCare

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