Utahs Limited Medicaid Expansion Was Costing The State More And Covering Fewer People Than Full Expansion
But just weeks after the 2018 election, GOP lawmakers in Utah intervened to stop the implementation of the Medicaid expansion that voters had approved, opting instead for a version of Medicaid expansion that would cover fewer people and cost the state more, at least in the first few years. S.B.96 was enacted in the 2019 legislative session, reiterating H.B.472s call for Medicaid expansion only to those with income up to the poverty level.
S.B.96 was enacted in February 2019. The states Medicaid expansion ballot initiative had called for expansion to take effect by April 2019, which meant there was very little time to secure federal approval for the modifications the GOP lawmakers wanted to make to Utahs version of Medicaid expansion.
But since the state already had a pending waiver proposal at CMS with very similar terms to those called for in S.B.96, CMS was able to grant a modified approval of that earlier proposal albeit at the states regular federal funding match rate of about 68%, instead of the 90% federal funding rate that applies in states that have fully expanded Medicaid. The approval came in late March, just in time for the state to implement its limited Medicaid expansion on April 1, 2019. Utah residents with income up to the poverty level were able to begin applying for expanded Medicaid at that point.
In addition to partial Medicaid expansion, Utahs approved waiver also allows the state to impose a Medicaid work requirement starting in 2020 .
Despite Partial Expansion Utah Wanted Enhanced Federal Funding That Applies To States With Full Expansion But Cms Said No
The Utah Department of Health published an implementation guide for the limited Medicaid expansion and the states future plans. It noted that an estimated 70,000 to 90,000 people would be covered under the newly approved version of Medicaid expansion. And Utahs limited Medicaid expansion did eliminate the coverage gap in the state.
But about 45,000 more people would have been eligible for Medicaid if the state had implemented the Medicaid expansion ballot initiative . Instead, these individuals continued to be eligible for substantial premium subsidies and cost-sharing subsidies in the exchange in 2019 .
Utahs 2018 waiver proposal based on H.B.472 and mostly approved by CMS in March 2019 requested enhanced federal funding for Utahs limited Medicaid expansion proposal . Although CMS granted temporary approval for Utah to expand Medicaid to adults earning up to the poverty level and impose a work requirement as of 2020, CMS clarified that the state would only receive its regular federal funding match, which is about 68%.
Because 32% of the cost of covering up to 90,000 people would have been a larger amount than 10% of the cost of covering up to 130,000 people, Utahs initial approach actually would have resulted in the state spending more of its own money to cover fewer of its residents.
Very Limited Expansion Was Approved In 2017 Enrollees Were Transitioned To Expanded Medicaid In 2019
In March 2016, Utah Governor Gary Herbert signed HB437 into law, providing for a limited version of Medicaid expansion. Utahs version was much less comprehensive than the Medicaid expansion called for in the Affordable Care Act . Utah House Majority Leader Jim Dunnigan noted that the legislation targets those in extreme poverty.
Instead of expanding coverage to roughly 130,000 people , HB437 was expected to provide Medicaid coverage to about 9,000 11,000 of Utahs poorest residents . The limited expansion provided Medicaid for 12 months to Utahns who are homeless, mentally ill, in need of treatment for substance abuse, or recently released from incarceration.
Utahs limited expansion of Medicaid was slated to cost the state about $30 million a year , and the federal government about $70 million a year. Democratic lawmakers who felt that HB437 was less than crumbs noted that full expansion of Medicaid would have cost the state $44 million a year , but would have brought in $420 million a year in federal funds, garnering far more value from those state dollars.
Utah submitted a Section 1115 waiver proposal to CMS in July 2016, but CMS quickly responded, asking for additional information and an additional public comment period. The state had planned to implement the limited Medicaid expansion proposal in January 2017, but CMS approval didnt come until October 31, 2017.
In 2019, Utah transitioned Primary Care Network enrollees to the Medicaid expansion program.
You May Like: How Do I Pick A Plan For Medicaid
How To Get Both Medicare And Medicaid In Utah
If you are eligible for Medicaid in Utah but also meet the qualifications for Medicare, you can benefit from both programs! You can qualify for Medicare by turning 65, by having ALS or ESRD, or by receiving disability benefits for at least 24 months.
If you do qualify for both programs, you can enroll in a Medicare Advantage Dual Special Needs Plan . A DSNP can cover most or all of your health services at very little or no cost to you. DSNPs are unique to people who qualify for both Medicare and Medicaid and can be the cheapest way for you to get the coverage you need. However, there are hundreds of these plans available. For help finding the best plan in your county, speak with one of our licensed agents by calling 833-438-3676 or sending us a message.
Full Medicaid Expansion Begins In Utah Heres How To Check If You Qualify
Supporters of Medicaid expansion attend a rally on March 5, 2015. Following several years of debate and legislation replacing a voter-approved expansion initiative, Utah will fully expand Medicaid services to individuals earning up to 138% of the federal poverty level on Jan 1, 2020.
After years of debate over how to administer Medicaid in Utah, the state has moved to a fully-expanded the program for low-income residents beginning Wednesday, guaranteeing access to health care for tens of thousands of people.
The move to full expansion means that anyone earning less than 138% of the federal poverty level roughly $35,000 for a family of four or $17,000 for an individual is now eligible for Medicaid services. Individuals interested in checking their eligibility or applying for Medicaid can do so by visiting the offices of the Division of Workforce Services or by completing an online application at medicaid.utah.gov.
This is a proud moment for Utah, Matt Slonaker, executive director of the Utah Health Policy Project, said in a prepared statement. Full expansion goes live January 1st, 2020.
Wednesdays rollout follows the rejection of a partial expansion program approved by lawmakers in February, which itself replaced the voter-approved Proposition 3, which sought full expansion for the state.
Slonaker said this expansion has arrived later than and with different requirements from how advocates hoped it would. But he described the change as transformative.”
Read Also: Dentist In Little Rock That Accept Medicaid
What Is The Income Limit To Receive Medicare
Your income isnt a factor in your ability to sign up for Medicare in Utah. Its a different story with Medicaid .
When it comes to Part A of Original Medicare, having earned income over your lifetime is, in fact, a positive. If you have worked at least 10 years, you dont pay a monthly premium for Part A. If you havent worked 10 years but a spouse that is at least 62 years old has, then that also qualifies you.
With Part B, some higher-income earners may have to pay more than the standard premium. In 2022, for example, the standard monthly premium for Part B is $170.10. That rate increases if your individual income, based on your 2020 tax return, is more than $91,000. The Centers for Medicare & Medicaid Services estimates that only seven percent of Medicare beneficiaries are impacted.
What Are 4 Types Of Medicare Advantage Plans
While Original Medicare is only one plan, Medicare Advantage in Utah comes in all shapes and sizes.
The cost savings inherent in Medicare Advantage plans are possible in part because beneficiaries get favorable rates when they visit providers within a regional network. Those networks are set up within four different types of Medicare Advantage plans.
- Health Maintenance Organization plans use provider networks. HMOs typically require that the policy holder designate a primary care physician that provides referrals if you need to see another doctor.
- Preferred Provider Organization plans give you the freedom to see any doctor in your network without a referral.
- Private Fee-for-Service plans pay your providers each time you receive a service.
- Special Needs Plans are for patients with specific diseases or financial situations.
You May Like: How Much Will Medicaid Pay For Assisted Living
Health Program Representative / Medicaid
Once you have become approved for Medicaid through the Department of Workforce Services , you will need to choose your Primary Care Provider.
The Medicaid Health Program Representative at the Tooele County Health Department can help you with this process. Please phone 277-2320 and ask to speak with the Medicaid Health Program Representative .
Health Program Representatives will help you understand your Medicaid benefits. HPRs provide education so you can learn about your Medicaid benefits and provider options.
If you live in Utah, Salt Lake, Davis, Weber, Box Elder, Cache, Iron, Morgan, Rich, Summit, Tooele, Wasatch, or Washington Counties, you must choose a health plan for your medical care.
If you live in any other county in Utah, you may have a choice of selecting a health plan or using the Fee for Service Network. An HPR will help you choose a health plan or network that will work best for you.
HPRs are NOT eligibility workers and cannot help with eligibility questions or concerns. If you have questions about your eligibility, please call the Department of Workforce Services at 1-866-435-7414.
To contact an HPR, please call 1-866-608-9422.
For more information visit
Other resources:
Todays Air Quality
Estimate How Much You’ll Pay For Out
If you apply for Medicaid and arent eligible, here are your options to determine your out of pocket health care costs:
We’ve developed a tool that helps you compare and estimate how much you’ll pay out-of-pocket for different health services and procedures.
University of Utah Health is trying to make this process easier by providing you a tool that helps you calculate how much youll have to pay out-of-pocket for common health care services.
Also Check: Michigan Medicaid Waiver Assisted Living
Acas Medicaid Eligibility Expansion In Utah
Medicaid was partially expanded in Utah as of April 2019. But under the terms of a new waiver that CMS approved in December 2019, the state fully expanded Medicaid as of January 2020 albeit with a work requirement, as described below .
Medicaid coverage is available to adults age 19-64 with household income up to 138% of the federal poverty level . For a single adult, thats $17,774 in annual income as of 2021 .
As of May 2021, there were more than 60,000 low-income adults covered under Utahs Medicaid expansion program.
The previous partial Medicaid expansion in Utah granted eligibility to adults age 19-64 with income as high as the poverty level . But Utah was not receiving the enhanced federal Medicaid expansion funding, which under the ACA requires expanding eligibility to 138% of FPL. Now that the full expansion has taken effect, Utah is receiving full Medicaid expansion funding for the entire Utah Medicaid expansion population, including the group that had already gained coverage under the partial expansion.
Learn How To Apply For Medicaid In Utah
UPDATE: In 2020, the rules and steps related to applying for Medicaid are expected to remain the same.
Where do you sign up for Medicaid in Utah? Finding out where to apply for Medicaid in Utah is the first step for applying for health care coverage. The Utah Medicaid application process ensures Utahs most at-risk and low-income populations can access health insurance on an as-needed basis.
The Utah Medicaid application form to request benefits is available to pregnant women, the blind, disabled and applicants older than 65 years of age. The Department of Workforce Services processes all UT Medicaid applications and uses an online system to verify eligibility and income. Each applicant is assigned a caseworker that can help answer questions regarding applications, eligibility, coverage details and the length of ones coverage.
To find out how to apply for Medicaid in Utah, review the details provided in the sections below:
Also Check: Is Oregon Health Plan Medicaid
Which Company Has The Best Medicare Advantage Plan
The Centers for Medicare & Medicaid Services has a Medicare Star Rating system that assigns a rating of one to five stars to individual Medicare Advantage plans.
If youre already on a Medicare Advantage plan and its not five-star plan, you are offered the opportunity to switch to a five-star plan each year.
While the rating system can shed light on Medicare Advantage plans performance, its not as easy as just picking the highest-rated plan. A dedicated GoHealth licensed insurance agent can review your situation and figure out what Medicare Advantage plan is the right fit for your specific situation.
Get real Medicare answers and guidance — no strings attached.
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation by National, State & County
Average HCC Score:The Hierarchical Condition Category score gauges a populations overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Who Is Currently Eligible For Medicaid In Utah
Utah was among the states that initially implemented Medicaid in the first year it was available their program became effective in . Coverage is available under the following eligibility rules:
- Pregnant women with household income up to 139% of poverty are eligible for Medicaid. The mother receives full Medicaid coverage throughout the pregnancy and for 60 days postpartum.
- Children with household incomes up to 139% of poverty are eligible for Medicaid in Utah .
- Women with household incomes up to 250% of poverty are eligible for certain cancer screenings through the Utah Cancer Control Program . If they are found to have breast or cervical cancer during the screening, they are eligible for full Medicaid coverage. If they have a precancerous condition , they are eligible for three months of Medicaid coverage.
- Adults in Utah can get Medicaid coverage if their household income is up to 138% of the poverty level.
- Utah provides Medicaid for various other select populations check their list to see if you might be in any of the eligible groups.
Our guide to financial assistance for Medicare enrollees in Utah includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
Read Also: How To Cancel Medicaid In Virginia
Utah Medicaids Accountable Care Organizations
Utah Medicaid currently works with four Accountable Care Organizations, which are sort of like health plans. Anyone in Box Elder, Cache, Davis, Iron, Morgan, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, or Weber counties is required to select one of the four. Anyone in another county can choose an ACO but does not have to. The benefit of joining an ACO is that they might offer additional benefits that the Medicaid program does not provide on its own. The advantage of not selecting an ACO is that you can see any doctor that accepts Utah Medicaid insurance.
Anyone who lives in one of the counties listed above can change plans any time during their first 90 days. Additionally, anyone can change plans from mid-May through mid-June.
Utah Medicaid Income Limit
The Utah Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.
To qualify, you must meet the Utah Medicaid Income limits listed below.
Here is the Federal Poverty Level for 2021.
| 2021 Federal Poverty Levels for the 48 Contiguous States & D.C. |
| Household Size |
Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:
- Children up to age 1 with family income up to 139 percent of FPL
- Any child age 1-5 with a family income up to 139 percent of FPL
- Children ages 6- 18 with family income up to 139 percent of FPL
- CHIP for children with family income up to 200 percent of FPL
- Pregnant women with family income up to 139 percent of FPL
- Parents of minor children with family income up to 41 percent of FPL
- Individuals who are elderly, blind, and disabled with family income up to 100% of the FPL
- Adults without dependents under Medicaid expansion with income up to 133% of the FPL
Donât Miss: How Much Can You Make And Still Receive Medicaid
Don’t Miss: Paramount Medicaid Ohio Phone Number
How To Apply / Learn More
State social workers prioritize individuals who currently reside in a state licensed nursing home or medical facility. For those who are interested in this program and do not currently live in a skilled nursing center, they must apply during three, 2-week, open enrollment periods starting on March 1, July 1, and November 1.
As this program is designed for persons already receiving Medicaid services and residing in nursing homes, interested parties should contact their nursing home or Medicaid administrators with questions regarding processes and availability. One can request application forms and instructions by dialing 662-9651, and selecting number 6.
The New Choices Medicaid Waiver is operated by the Utah Division of Medicaid and Health Financing. For additional information about this program, .
How Do I Qualify For Pregnancy Medicaid In Utah
How to Qualify:
You May Like: How To Get Both Medicare And Medicaid
Read Also: Eye Care Places That Take Medicaid
