Report: Trump administration to reject Utah’s bid for limited Medicaid expansion

Utah Capitol 18

The Washington Post reported Friday that the Trump administration is poised to nix Utah’s request for increased federal funding to implement a stripped-down Medicaid expansion.

Utah voters approved Prop. 3 in November, which implemented full Medicaid expansion under the Affordable Care Act. that would give Medicaid coverage to Utahns earning up to 138% of the federal poverty level. Under the expansion, the federal government would cover 90% of the cost of the expansion, while the state would be responsible for the remaining 10%.

During the 2019 session, lawmakers overrode Prop. 3 in favor of expanding Medicaid to Utahns earning 100% of the poverty level. They also plan to submit a waiver request to the Trump administration to approve the 90/10 financial split even though they are not increasing coverage to the level mandated by the ACA.

The Post reports the Trump administration does not plan to give Utah the generous financial split for expanding coverage to fewer people because the White House is challenging the constitutionality of the ACA in court.

The administration is siding with 18 Republican attorneys general arguing in federal court that the entirety of the Affordable Care Act — which extended health insurance to some 20 million Americans through individual marketplaces and expansion of Medicaid — is unconstitutional. A decision from the Court of Appeals for the 5th Circuit is expected in the coming weeks.


According to the senior officials, who spoke on the condition of anonymity to discuss internal deliberations, White House advisers argued that it did not make sense to approve generous federal funding under the ACA while the administration is arguing that the entire law should be overturned.


White House advisers on the Domestic Policy Council, Office of Management and Budget, and National Economic Council, which are controlled by conservative Republicans, were the staunchest opponents of allowing Utah to receive enhanced federal funding for its expanded Medicaid program. CMS Administrator Seema Verma presented Utah’s argument for receiving the enhanced funding in a meeting with several White House and health agency officials, but the decision to deny such requests was ultimately unanimous, a senior administration official said.

Utah said it still plans to submit a funding request to CMS. “We’re still preparing to submit our waiver as directed by state legislation passed this year,” said Tom Hudachko, spokesman for the Utah Department of Health. “We have not received any indication, one way or the other, how CMS may act on the waiver once we do submit it.”

In addition to the more modest expansion, the replacement bill passed by lawmakers includes a work requirement for recipients. Similar work measures blocked by a federal judge after Kentucky and Arkansas tried to implement them.

If Utah does not receive the requested waivers within 2 years, the replacement bill reverts to the full Medicaid expansion passed by voters. But, if the law is struck down in court, that would be moot.