Utah: Hooray! Medicaid expansion for 70,000 signed into law!..um...sort of.

2018 MIDTERM ELECTION

Time: D H M S

via the Salt Lake Tribune:

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. Meanwhile, a competing Utah citizens initiative that would expand Medicaid coverage more widely than HB472 also continues to gather signatures for a spot on November’s ballot.

At a signing ceremony Tuesday at the Utah Capitol, Herbert, lawmakers and other officials were nonetheless thrilled to make it this far. Past efforts to expand Medicaid under the ACA failed repeatedly as conservative lawmakers expressed concern over potentially ballooning costs.

And, of course, Utah being a red state and work requirements being all the rage among GOP officials these days...

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.

Yup...a 100% FPL cut-off instead of the ACA's standard 138%. To be perfectly frank, this bothers me far less than the work requirement and spending cap provisions, since those earning over 100% FPL can get heavily-subsidized ACA exchange policies. That's hardly ideal, of course, but it's a hell of a lot better than nothing. I'm not alone in this:

...Officials with the nonprofit Utah Health Policy Project have said Utah’s work requirement and spending caps could result in some impoverished Utahns, who should qualify for coverage, being left out.

However, there's also another twist. As noted above...

At the same time, Utah’s Medicaid ballot initiative — if it passes in November — would expand Medicaid to those making 138 percent of poverty income levels, or 150,000 more people than are covered currently. Organizers of that initiative continue to collect the necessary 113,000 signatures to qualify for the ballot ahead of an April 15 deadline.

Either way, don't expect Utahns to start enrolling anytime soon:

...Officials expect it will be at least six to nine months before CMS issues its decision on the waiver. And it could be several months beyond that — into 2019 — before Utah is prepared to enroll tens of thousands of new Medicaid recipients.