Initial Medicaid Implementation: Utah began their Medicaid program in July of 1966. When the program began, it was estimated that 20% of the population would be eligible for coverage. By the time the program was up and running, 4% of the Utah population was utilizing the program. The program focused on acute and long-term care at the beginning, later adding more services that would focus on chronic and care for other populations.
Key Medicaid Political Issues: In the early 2000’s Utah’s Governor Mike Leavitt negotiated a waiver demonstration for certain eligible adults up to 150 percent of the poverty line. The demonstration included cost-sharing for low-income individuals and primary care services. It was a limited hospital benefit with limited ability for hospital treatment outside of the emergency department. One interesting aspect of this waiver and the role of Governor Leavitt as CMS Administrator following his time as governor is that during the Clinton Administration, Utah and Governor Leavitt were opposed to block granting Medicaid because that would put states up for extra costs, but this waiver had limitations on the benefits and the amount of services that were available to beneficiaries in a way that would be similar to what a block grant would look like.
Medicaid Expansion Implementation: Utah expanded Medicaid through their initiative process that was later amended through a waiver. The state had made several attempts to expand prior to the introduction of the ballot initiative and had passed a waiver that would expand services to certain low-income individuals who would be ineligibile for Medicaid previously. The plan had significant barriers to enrollment including work requirements and a proposal to block grant the Medicaid program. The state submitted this waiver plan to CMS prior to the November vote. After the initiative was passed in November of 2018 it appeared that the state would implement the Medicaid expansion without changes, but then the legislative trigger of the initiative having an expected expense of 25% greater than the estimated cost. The legislature voted to require the state to submit an 1115 waiver that would ask for a partial Medicaid expansion or a Medicaid expansion up to 100% of the federal poverty level instead of 138% level but with the full expansion federal funding. Previously, CMS has rejected state requests for the partial expansion. The waiver request requirements also included other limits on Medicaid expansion eligibility including a work requirement and limits on retroactive eligibility. The plan defaults to Medicaid expansion to the full 138 percent of poverty if the state does not receive a waiver from the federal government. The waiver also included a block grant proposal and enrollment caps. The original plan to add work requirements to Medicaid did not include refugees in the requirement, the only state to do so.
General facts about Utah Medicaid:
Medicaid program name: Medicaid
CHIP Program name: CHIP
Separate or combined CHIP: Separate
Medicaid Enrollment: 285,000 (2018 estimate)
Total Medicaid Spending: $2.5 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 10%
Share of Children covered by Medicaid: 20% (estimate)
Share of Medicaid that is Children and Adults: 84%
Share of Spending on Elderly and people with disabilities: 53%
Share of Nursing Facility Residents covered by Medicaid: 50% (estimate)
Expansion state: Yes*
Number of people in expansion: NA
Work Requirement: Under development