October 04, 2019

Fallback Fallout: A look at the provisions in Utah’s new “Fallback” Medicaid expansion proposal, the impact on kids & families, and what you can do

For those following the Legislature’s complicated, multi-step 'repleal and replace' of Proposition 3, Full Medicaid Expansion, Utah is now moving onto its third- and potentially final- phase. As a reminder…

Phase 1: Senate Bill 96 directs Utah to pay more money to only partially expand Medicaid. On April 1st, Utah partially expanded Medicaid (up to 100% of the federal poverty level) but receives fewer federal dollars to do so. The upside is that Medicaid is currently OPEN for individuals up to 100% FPL. But the downside is that every month, Utah is losing money to cover FEWER people; money that could be spent keeping kids covered or helping families get enrolled.

Phase 2: State officials, at the direction of Senate Bill 96, attempted to get more money from the federal government to cover fewer people. The federal government rejected this waiver.

Phase 3: State officials are now proposing to cover more people through Medicaid (those up to 138% of the federal poverty level), which will help more individuals get coverage-- also called the “fallback” plan. Utah will be able to draw down more of our federal tax dollars by expanding up to 138% FPL. But Utah is also proposing to impose additional restrictions, barriers and red-tape on Medicaid enrollees. Those most targeted are the newly eligible individuals making approximately $12,000-$17,000 every year.

Research shows that adding on additional barriers, extra costs, penalties and restrictions for enrollees ultimately keeps eligible individuals from getting enrolled and staying enrolled. At a time when the number of adults and children without insurance is actually increasing, we should be doing all we can to help eligible people get enrolled and stay enrolled, instead of enacting policies which undermine this new coverage opportunity. You can see the full list of proposed changes here.

In sum,

The Good News: Utah is closer than ever before to expanding Medicaid fully, as voters approved last year.

The Bad: Unfortunately, the state is tacking on some harsh restrictions to full expansion, which will hurt families and the Medicaid program going forward.

Utah voters supported a straightforward full Medicaid expansion, without extra penalties or restrictions that create more barriers to coverage and care. Let's advance the Good (Full Expansion!), but stop the Bad.

What can you do? Comment!

Your comments are needed for this final phase. The federal government must consider every unique comment.  Comment here by Decemer 7th!

Miss the comment period? Contact the Governor! Show your support for full expansion now, with a January 2020 start date. Together we can help Utahns get the care and coverage they need!

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