SALT LAKE CITY — The Utah Department of Health told legislators Thursday that federal officials have given positive signs about approving an amended Medicaid expansion waiver, which may mean some Utahns are currently likely to benefit from coverage as early as Nov. 1.
The waiver, which was submitted earlier last week, is undergoing a review by the Centers for Medicare and Medicaid Services, said Nate Checketts, director of Medicaid and health financing for the Utah Department of Health.
It is expected to be opened up to 60 days of public comment at the federal level by the end of the month. The amended waiver has already undergone a state public comment period.
The waiver would secure the expansion of Medicaid coverage for 6,500 Utahns who are experiencing chronic homelessness, need treatment for drug addiction or mental health problems, and some who have had interaction with the criminal justice system.
While conceding that it’s “hard reading the tea leaves,” Checketts told the state Legislature’s Health Reform Task Force on Thursday that he is encouraged the waiver’s approval is on the near horizon.
“Our best indication is that they are going to approve it,” he said. “They have not indicated that is not a goal that we are going to be able to meet.”
Utah settled on seeking the small-scale expansion after legislators rejected multiple efforts at more comprehensive enlargement of Medicaid coverage in the state, enabled by the Affordable Care Act that would have covered 90,000 additional Utahns, initially using exclusively federal funds but later requiring a state match.
Another small group of low-income Utahns, numbering roughly 3,000 to 5,000, are guaranteed to receive Medicaid, health department officials announced in February. But expansion for the homeless, addicted and mentally ill population of about 6,500 was termed at the time to be less certain.
Multiple amendments have been added to the original waiver that “had been discouraged by the (Obama) administration at the time,” which is the reason they weren’t included initially, Checketts explained. Federal authorities under new President Donald Trump have been more receptive to the ideas behind those amendments, he said.
Those amendments include a five-year coverage limit for some who are expected to be among the Medicaid expansion group beginning in November, as well as a “work requirement” needed for certain coverage eligibility for some in that group. They would also allow for greater autonomy on the part of the Utah Department of Health in adjusting eligibility parameters for the expansion group.
Rep. Marie Poulsen, D-Salt Lake City, voiced reservations about the work requirement, citing submissions during the state public comment period that said the measure soured the waiver as a whole and made it “woefully inadequate.”
Checketts responded by pointing out flexibilities proffered in the work requirement, including an exception for any person over 60 or any person with a dependent child under the age of 6. That exception was added in response to the public comment, he said.
Under President Barack Obama, the federal government had butted heads with Utah leaders over the issue of including any work requirement in Medicaid expansion.
Sen. Gene Davis, D-Salt Lake City, took issue with the amendment that would install five-year limits on Medicaid coverage for some of the expansion group. He said it particularly bugged him because of the chronic nature of the health problems known to plague that group: mental illness and substance abuse.
“Their illness does not end in five years. …. The recidivism that’s going to take place is just unbelievable,” he said.
Andrew Riggle, public policy advocate for the Utah Disability Law Center, promised to drum up opposition to the amendments during the waiver’s federal comment period.
“All those (amendments) will have the effect of limiting access to care,” he said.
Riggle also singled out eligibility time limits, saying they don’t make sense for a population “who have recurring or episodic mental health or substance abuse needs.” He also said a work requirement has been shown not to work in other states and that carve-outs for parents of young children and seniors “may look good on paper but may not work as effectively as they were intended to.”