The six states that can't decide on Medicaid expansion


Representatives from Gov. Gary Herbert’s office are in D.C. discussing his Medicaid expansion plan with administration officials this week. The state is currently moving forward with the Republican governor’s plan, after proposals from the state House and Senate failed to advance before the close of the legislative session last week.

After refraining from opting in for a long while, Herbert made it clear in January that he wanted to do something about Medicaid expansion, but he did not clarify what approach that might be until recently.

The governor’s Healthy Utah plan would expand coverage to adults below 138 percent of the federal poverty level, and use federal funds to buy private insurance for low-income adults. The plan would seek a federal block grant to cover the approximately 111,000 Utahns under the income threshold. The three-year pilot program would accept $258 million in federal funds in 2015.

“It’s more robust [than the House and Senate proposals],” says Kolbi Young, spokesperson for the Utah Department of Health. The House plan involved only state dollars with no new Medicaid funding, while the Senate plan accepted federal funding but only expanded coverage to 100 percent of the poverty level.

Because neither plan was passed, the governor is moving ahead with his own.

The Healthy Utah plan includes elements of personal responsibility as well. It involves some cost-sharing, and those making below $15,521 would pay $420 in annual premiums and medical costs. There is not an official work requirement in the proposal, but the motto associated is “those who can work, do work.”

It is not yet known what the administration’s response will be. “The plan has not been presented to CMS,” Young says. “That’s the next step.”