Report: Utah officials started working to replace voter-approved Medicaid expansion just days after the November election

Utah Capitol 21

Politico is out with a big scoop Friday morning that Utah officials started putting pressure on the Trump administration to approve a scaled-back Medicaid expansion plan within days of voters approving Prop. 3.

According to emails and text messages obtained through a GRAMA request, state and federal officals began discussing a Medicaid expansion plan that was less comprehensive than the full expansion approved by voters. The discussions included whether the Trump administration would approve a plan that covered fewer people than Prop. 3 as well as enrollment caps and limits on spending. 

State lawmakers repeatedly insisted during the effort to pass their scaled-back version of Medicaid expansion they had received assurances that the Trump administration would approve the plan. None of the documents reviewed by Politico indicated whether federal Medicaid officials were on board with Utah’s efforts.

The documents obtained by POLITICO show that the state, shortly after the election, ramped up pressure on the Trump administration to decide whether to allow partial expansions. These discussions occurred weeks before Utah Republicans introduced their legislation shrinking the voter-approved expansion, angering supporters of the ballot initiative.


(Utah Medicaid Director Nathan) Checketts and top Trump health officials, including then-Medicaid head Mary Mayhew and CMS senior counselor Calder Lynch, were in frequent contact during the following weeks.


“We know the state’s request would be something new for CMS and represents a significant policy decision. Therefore, we understand why CMS has taken time to review and consider the state’s request,” Checketts wrote to senior agency officials on Nov. 20, shortly after they had discussed the proposal during a conference in Washington, D.C.


“Even if CMS is not able to approve this request, our policymakers will benefit from knowing which options are (or are not) likely to be approved,” Checketts continued.

Ten days later on Nov. 30, Checketts wrote to Mayhew and Lynch that the governor’s office was “reemphasizing our state’s interest in getting a response” on its partial expansion request. About two weeks later, in mid-December, CMS Administrator Seema Verma spoke with Utah Gov. Gary Herbert about the plan, according to the emails.

The Affordable Care Act requires states to expand Medicaid coverage to residents earning below 138% of the federal poverty level in order for the federal government to cover 90-percent of the cost. Utah is asking the Trump administration to extend that 90/10 cost split for only covering low-income residents up to 100% of poverty, which is about 60,000 fewer people. The federal government has never approved such a waiver.