Utah running into roadblocks on legislature-approved Medicaid expansion

Utah GOP state lawmakers have found a friend in President Donald Trump when it comes to Democratic-imposed national monuments.

Not so much on Medicaid expansion.

Tuesday, Politico published a story saying that Utah’s Medicaid waiver requests, among other states’, before the Trump administration is in trouble.

Specifically, the federal Medicaid bosses denied a Kanas-requested waiver on lifetime state spending limits.

Utah has asked for a similar waiver.

And while there was big talk in the 2018 general session by Utah GOP leaders that they expected to get several waivers – now that hope has diminished a bit.

Rep. Jim Dunnigan, R-Taylorsville, who has been at the forefront of Utah’s Medicaid expansion debate, tells UtahPolicy there is still hope that the feds will give Utah waivers on several critical points:

— An expanded 90-10 financing match by the feds that will cover Utahns up to 100 percent of the federal poverty level.

That’s a big one, as it will allow for around 50,000 adult Utahns to be covered under Medicaid expansion.

— Provide enrollment caps to meet state spending levels.

— Allow for some on Medicaid to work or become trained so perhaps they can get jobs and get off of Medicaid.

The Kanas decision could affect around 19,000 adults in Utah, said Dunnigan, in two different classified groups.

You may recall that the Utah Legislature has a much-checkered history when it comes to Medicaid expansion under the Affordable Care Act or Obamacare.

Utah Republican state leaders refused to take the whole ACA Medicaid expansion, with GOP Gov. Gary Herbert coming up with his own Healthy Utah program, which would cover around 126,000 lower-income Utahns.

The state Senate adopted Healthy Utah – but needed a few Democratic votes to get there.

The Utah GOP House at first refused to even take Healthy Utah up – then killed it. Instead, a year or two later, the GOP House pushed through a much-scaled-down Medicaid expansion, which ended up covering fewer than 10,000 low-income Utahns.

After Trump’s election, state GOP lawmakers made an about turn.

Last session they passed a new version of Medicaid expansion – covering around 60,000 people — one that would require work/training for Medicaid recipients – as Trump authorized.

But state Republicans continued to worry about how much Medicaid expansion would cost future state budgets – and so sought federal waivers on capping state costs down the road.

Some other states tried similar cost-saving Medicaid assurances – like Kanas, which wanted the authority to end Medicaid coverage after three years in certain cases.

And now Kanas has been denied such a cap, Politico and Dunnigan say.

The news about Kanas’ waiver failure puts renewed energy into a full-Medicaid expansion citizen initiative petition that just this last week achieved the required number of voter signatures to make the November ballot.

The petition, if approved by voters, would increase the state sales tax by 0.15 percentage points to provide new monies to help pay for putting more than 160,000 low-income folks on Medicaid.

The sales tax hike would bring in around $90 million. And the governor’s budget office estimates adding the new folks to Medicaid would cost around $77 million a year – although that $77 million cost could go up over time.

It could be around a year before Utah learns if its other waiver requests are approved or denied.

But if the petition passes in November, then Utah leaders will be instructed to apply for the full Medicaid expansion under Obamacare, and the state sales tax will go up slightly.