Utah: 150,000, 70,000 or 0? Medicaid expansion on the ballot in November

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

A couple of weeks ago I reported that the state legislature and governor of deep red Utah has agreed to partly expand Medicaid under the ACA...

Gov. Gary Herbert signed a measure Tuesday to give more than 70,000 needy Utahns access to government health coverage, ending years of failed attempts on Capitol Hill to expand Medicaid in the state.

But whether House Bill 472 ever takes effect still remains uncertain. Under President Obama’s signature Affordable Care Act (ACA), the Utah law needs approval by the federal Centers for Medicare and Medicaid Services (CMS), which has sent mixed signals on whether it will fully sign off.

Even if CMS does approve HB472, it will likely be about a year — even on an aggressive schedule — before the state can begin enrolling people for coverage.

...but with two major caveats:

...HB472 also requires enrollees to prove they are working or participating in volunteering, vocational training or similar activities. The Trump administration has told state officials it is receptive to such tweaks requested by individual states, which were nonstarters under the Obama administration.

...Yet it remains unclear if even Trump’s CMS will approve one key provision Utah is proposing. The HB472 plan calls for only a partial expansion of Medicaid coverage for adults making up to 100 percent of the poverty line, or $12,140 annually for a single person.

Yep, it would cut expansion off at 100% FPL instead of 138% as standard ACA expansion is supposed to, and it would impose an utterly pointless and harmful work requirement on top of that. However, it's Utah, so folks should take what they can get, right?

Well, apparently a lot of Utahns have decided "nope, we're gonna raise the bar and go for it" after all:

Medicaid expansion initiative set for Utah ballot

Utah voters are poised to vote on Medicaid expansion after an advocacy group raised enough signatures to put the issue on the ballot in November.

More than 165,000 signatures will be submitted Monday to place a Medicaid expansion initiative on the ballot. Organizers from the group Utah Decides Healthcare needed more than 113,000 signatures from registered voters to earn a ballot spot.

If approved, the initiative would require the state to expand Medicaid to people making up to 138 percent of the federal poverty level, and would prohibit enrollment caps.

Under ObamaCare, the federal government would cover 90 percent of the costs of expansion. The state share would be funded through a 0.15 percent increase in the sales tax.

...The ballot initiative would cover more than 150,000 people.

CMS has never approved a partial expansion when other states have tried.

So in short, here's where things stand:

  • If the ballot proposal passes, 150,000 people will receive Medicaid coverage with no strings attached...but there's no guarantee it'll pass.
  • If the ballot proposal fails, 70,000 people may receive Medicaid coverage but with the work requirement attached...and there's no guarantee it'll be approved.