The Trump administration today approved Utah’s request for a scaled-back Medicaid expansion with a work requirement just days after a federal judge blocked similar rules from taking effect in Kentucky and Arkansas.
The approval also lets Utah cap program enrollment if the state runs out of money and marks the first phase of a plan to replace a Medicaid expansion voters approved last November with a scaled-down program covering roughly 60,000 fewer people.
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The Utah plan will initially cost the state tens of millions of dollars more and was spearheaded by Republican leaders critical of Obamacare’s Medicaid expansion. Liberal groups caused an uproar earlier this year as the legislature quickly moved to override the ballot initiative, saying the GOP lawmakers were blatantly defying the will of the people.
Utah’s new program will extend benefits to adults with incomes below the federal poverty line. The 2010 health care law required states to expand Medicaid to those earning up to 138 percent of the federal poverty line — or about $17,200 for an individual — in order to receive enhanced funding from the federal government.
In its approval letter, CMS also inserted language that could protect it from litigation. Legal aid groups in Kentucky, Arkansas and New Hampshire have sued to stop those states’ Medicaid overhauls. CMS wrote that the Utah plan provides coverage beyond what the state had done originally and therefore, it promotes Medicaid’s underlying purpose.
“Members of the Adult Expansion Population, absent the demonstration, would be ineligible for any Medicaid benefits, and absent approval of the amendment, would be eligible only for highly limited benefits,” the agency wrote.
Utah is still seeking Trump administration approval for two unprecedented ideas that HHS has so far declined to act on — obtaining the enhanced funding even when a state is covering fewer people than Obamacare envisions, and imposing per-person limits on the amount of federal funds the state receives. If these ideas are ultimately approved, it is likely to open the door for other Republican holdout states to adopt the coverage expansion after resisting it for years but will almost certainly trigger additional court battles.
Utah for now is relying on existing Medicaid funding to cover individuals up to the federal poverty line. Under the work requirement, which is less stringent than those of other states, Utah will require some Medicaid enrollees to complete the following activities to keep their coverage: register for work through an online system; complete an assessment of employment training needs; apply for a job; and complete online job training.
Coverage under the administration waiver is slated to take effect on April 1 and the work requirement will take effect in January. Poor adults earning above the poverty line, who would otherwise be enrolled in Medicaid expansion, will remain eligible to receive generous Obamacare subsidies to purchase private coverage.