Today, the Centers for Medicare and Medicaid Services (CMS) approved a proposal from Utah that imposes harmful and unprecedented restrictions on the Medicaid expansion program that Utah voters approved last November. This includes a limited expansion, a work reporting requirement and an enrollment cap. While this approval was long expected, and allows for some of Utah’s uninsured to enroll in Medicaid on April 1, it falls well short of the full expansion needed to truly close Utah’s Medicaid coverage gap.
All of this unfolds in stark contrast to the will of Utah’s voters who went to the polls in November 2018 and approved a clean, and full, Medicaid expansion for the estimated 150,000 residents who would be eligible. Despite a 53 percent majority who voted for the ballot measure, Utah’s legislators, along with Governor Herbert, rushed through a plan that costs more for the state, and covers fewer individuals. The approved request will allow for a limited expansion that will only cover between 70-90,000 individuals, rather than 150,000 individuals. In addition, the costs of the limited expansion will only be reimbursed by the federal government at a rate of 68 percent, far below the 90 percent reimbursement rate the state would receive under a full expansion.
Health advocates in Utah, including the Utah Health Policy Project and many others, worked swiftly to define the proposal in direct terms – a vote in support of SB96 was a vote to override the will of the voters who wanted a clean expansion. In fact, for those who won’t receive Medicaid through the limited expansion (i.e., individuals between 100 percent and 138 percent of the Federal Poverty Limit) who are currently uninsured, they will likely be barred from enrolling in coverage through the ACA marketplace until the January 2020 open enrollment period – as CMS denied the request to allow for a special enrollment period.
Not only does the limited expansion plan violate the will of voters, cover fewer individuals and cost more, but it also imposes harmful work reporting requirements (even as a federal judge vacated similar requirements in Arkansas and Kentucky this week), and most troublesome of all, a state cap on enrollment. This enrollment cap would place an arbitrary limit on the number of Utahns who could access the Medicaid program and significantly weaken the state’s flexibility to respond to a health outbreak, economic crisis or natural disaster. An enrollment cap on the Medicaid expansion program is an unprecedented policy that violates the purpose of Medicaid – which is to guarantee health coverage to all who are eligible.
We’ve entered into uncharted territory concerning the future of the Medicaid program and CMS’ willingness to fundamentally restructure elements of the program. Yet, one thing we know for sure is that none of these changes are in the best interest of Utahns, or the residents of states throughout the nation living with elected officials dead set on cutting care.