Utah’s partial expansion request

Utah’s governor just signed a bill that authorizes a 1115 Medicaid demonstration waiver. The waiver combines work requirements with a request. This is interesting on several levesl.

KUER reports:

The new law would ask the federal government to allow Utah to widen it’s low-income health insurance program. Right now, a single adult with Medicaid coverage can only make about $600 per year — essentially homeless. Under the new law, the same individual could be covered if they make anything up to the poverty level, approximately $12,000 per year.

It also adds a work requirement for those who qualify. If an individual is unemployed and wants Medicaid coverage, they’ll have to do things like get job training, volunteer or take classes.

This is interesting on several levels. First it is a red state with a Republican trifecta trying to expand Medicaid. They are asking for a work requirement but as far as I can tell the requirement would only apply to the expansion population. This is still a lot of people who make very little money so the vagaries of scheduling and intermittent work will be a massive implementation challenge but the work requirement is less restrictive than several that have been requested.

Far more interesting to me is that Utah is asking for a partial expansion. We’ve talked about partial expansions before.

The distributional consequences are important. For people who earn between 100-138% FPL in states that have not expanded Medicaid, nothing will change for them. They are no worse off. People who live on less than 100% FPL in these states will be dramatically better off as they will have Medicaid for their coverage….

More interestingly to me is that CMS recently turned down Arkansas’s request to change the enhanced match rate Medicaid expansion to 100% Federal Poverty Level (FPL) instead of the current 138% FPL. However there is a very critical difference: Arkansas had already fully expanded Medicaid. They went for the most expensive and convoluted system of expansion possible by sending most of the healthy population into the Exchange pool. That system costs 24% more than a straight up expansion of Medicaid but it got local buy-in. However Arkansas is now paying a fraction of the cost of expansion and they’ve been moving more of their private option population back into the less expensive legacy Medicaid system. The Arkansas proposal to shift the 100-138% FPL cohort to the Exchanges and off of Medicaid was an attempt to dodge previously obligated committments.

Utah has never expanded Medicaid. The 100-138% cohort is already on the Exchange and they are already eligible for federal subsidies. Expanding Medicaid to only 100% has no increase in costs for the Federal government on the Exchange side of the ledger. If there is only a partial expansion, the Feds are paying for the 100-138% cohort and if there is no expansion the Feds are still paying. This is a very different fact pattern than Arkansas so there is a chance that CMS could approve the waiver.

And if that is the case, then several more hold-out states would probably seek the same waiver.


8 replies
  1. 1
    evodevo says:

    Trying to get the Feds to cover all those underserved fundie Mormon communities? I know in Israel the equivalent population – orthodox Jews – have been gaming the social safety net programs for a long time.

  2. 2
    Mathguy says:

    Less than $600/yr to qualify in the current system? How evil do you have to be to run government that way?

  3. 3
    Procopius says:

    I haven’t been able to figure out what the reasoning is for demanding a work requirement. Are these people so detached from reality that they don’t realize starvation is an excellent reason for seeking employment if you’re physically and/or mentally capable of it? Withholding medical care which they couldn’t afford anyway is not much of an incentive. So instead of medicaid, where the doctors, nurses, and hospitals get low payments, the sick go to emergency rooms, where they can’t pay any part of the bill and the bills are jacked up about 300% for people without insurance anyway. There are many, many conditions emergency rooms do not and probably cannot treat. Don’t tell me there are laws requiring they treat everybody, the laws only require them to treat life-threatening conditions. They aren’t required to provide a continuous supply of insulin to diabetics or chemo-therapy to cancer patients.

  4. 4
    Matt says:


    The cost explosion isn’t a bug, it’s a feature. The work requirement being onerous is as well – the idea is to generate a situation where GOP pols can whip up the local Klavern voters with long-winded whinge about how we’re spending “so much money treating THOSE people who aren’t willing to work”.

  5. 5
    rikyrah says:

    But, they’re so Christian…
    Uh huh
    Uh huh

  6. 6
    rikyrah says:

    |Are you going to tackle the Op-Ed by the recently fired VA Secretary?

    David J. Shulkin:
    Privatizing the V.A. Will Hurt Veterans


    It seems that these successes within the department have intensified the ambitions of people who want to put V.A. health care in the hands of the private sector. I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for privatizing V.A. health services, however, reject this approach. They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.

    Until the past few months, veteran issues were dealt with in a largely bipartisan way. (My 100-0 Senate confirmation was perhaps the best evidence that the V.A. has been the exception to Washington’s political polarization). Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.

  7. 7
    FlipYrWhig says:

    @Procopius: Every Republican thinks everything is “welfare” and that Those People get things for free. That’s what they think Obamacare is: free medical treatment for black people and Spanish-speaking “illegals” and refugee terrorists and hipsters, sluts, and hipster sluts. They’re profoundly stupid and want to harm people who aren’t them.

  8. 8
    Ohio Mom says:

    I’m just going to snicker at all those states that refused the benefits the ACA would provide their citizens that are now trying to sneak their way in.

    Sure, they are camouflaging their entry with these inane work requirements but all I see in my mind’s eye is a dog slinking along with his tail between his legs.

    The work requirements can one day be revised and revoked, but these states aren’t ever going back to the pre-ACA system. The moral arc just bent a tiny bit more.

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