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Feds approve $100M Medicaid waiver for Utah’s most needy

Enrollment opens immediately, Gov. Gary Herbert says

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SALT LAKE CITY — Utah leaders, including Republican lawmakers and Democratic mayors, were all smiles as they gathered for a hasty announcement Wednesday, less than an hour after they got the green light from federal officials.

"I am so happy," House Speaker Greg Hughes said. "I am so, maybe, relieved."

After more than a year, the federal Health and Human Services Department on Wednesday approved Utah's long-awaited Medicaid waiver, which will bring in roughly $100 million in Medicaid services for 4,000 to 6,000 poor Utahns without children.

The waiver — including $70 million in federal dollars and $30 million in state and hospital dollars — also includes $10 million to go toward Operation Rio Grande (the effort to root out lawlessness and addiction in Salt Lake City's most troubled neighborhood) to fund 240 new residential treatment beds by the end of the year.

"We've been waiting for a long time," Utah Gov. Gary Herbert said, calling the announcement "a significant, important occasion" to "help those people that are the most vulnerable in our population "

Hughes said he "appreciated" the Donald Trump administration, "but it was almost to the point where I was going to do an Occupy HHS in their lobby."

"I was going to be a one-man band and go down there and not leave until they actually forced me out or until we got these waivers," Hughes said to laughs.

The waiver, after the Utah Legislature approved it in the 2016 session, awaited federal approval first under former President Barack Obama's administration, but stalled because of the transition to Trump's administration.

It wasn't exactly promising, either, when former Health and Human Services Secretary Tom Price resigned amid controversy over his travel expenditures — the day Herbert, Hughes, and other Utah leaders met with him last month in Washington, D.C.

Hughes joked that Rep. Jim Dunnigan, the sponsor of Utah's Medicaid waiver legislation, has been "stalking" Seema Verma, administrator of the Centers for Medicare and Medicaid Services, to get the waiver approved.

The Taylorsville Republican, laughing, said, "I wouldn't say I stalked her," but acknowledged that Verma remembered him from his efforts.

"It's terrific, I'm excited, and I'm not holding back!" Dunnigan shouted into the microphone to laughs and applause.

Verma said in a statement Wednesday that her team was "excited" to announce Utah's waiver approval and applauded Herbert "for taking this critical step to address the opioid crisis.” She said she looked forward to continuing to support Utah in its efforts.

Herbert said the waiver takes effect "immediately," with enrollment for the program opening Wednesday.

To be eligible, Utahns must earn no more than 5 percent of the federal poverty level and must be chronically homeless or be in the criminal justice system through probation, parole or court-ordered substance abuse or mental health treatment.

In the past, substance abuse treatment through Medicaid was limited to facilities with 16 beds or fewer, but under HB437, the Medicaid waiver legislation the Utah Legislature passed in 2016, the bed capacity limit will be lifted.

'Long-awaited day'

Lt. Gov. Spencer Cox said when talks began earlier this year about Operation Rio Grande, the Medicaid waiver was identified early on as a critical piece. He said the original plan was to have the waiver in place by January of next year, but leaders realized "that's not good enough."

Cox said Nate Checketts, director of Medicaid and Health Financing for Utah, told him approving it sooner wasn't likely, but he would try his hardest.

"I don't think any of us really imagined that (it would be approved) literally on Nov. 1," Cox said.

Salt Lake County Mayor Ben McAdams called Wednesday a "long-awaited day for us to deliver on behavioral health access care for many people in desperate need."

"It wasn't initially my preferred approach," McAdams added, "but this is the one that was able to garner enough support to move forward in Utah."

McAdams was a supporter of Herbert's Healthy Utah plan, which would have used nearly $1 billion in federal funds available under the Affordable Care Act to provide health care coverage to more than 126,000 Utahns, but it failed during the 2015 legislative session.

When lawmakers introduced the limited Medicaid waiver legislation HB437 in 2016 as an alternative, Herbert called the plan "better than zero," after he was unable to win support for his Healthy Utah plan.

But Wednesday, celebrating alongside Hughes, Dunnigan and other leaders behind HB437, Herbert and McAdams were cheerful.

"The path to today has seen a lot of ups and downs as we've worked to find common ground" locally and nationally, McAdams said. "And here we are today with success."

McAdams told a story of a woman he met who was hoping to be admitted into drug court and treatment programs. He said she was a young mother with a past of behavioral and substance abuse issues. He said at one point she got clean and married, had a job, but she returned to substance abuse after her 8-year-old son died of leukemia.

"I know there are many people like her who are looking for services and help," he said. "Not only is today a day of success to celebrate, but today is an answer to the prayers of families and loved ones of people who are in crisis right now."

Salt Lake City Mayor Jackie Biskupski said the waiver is "absolutely necessary for us to be successful" in trying to clean up the Rio Grande neighborhood.

"We will help people who are chronically homeless, and we will help move them off of our streets," she said. "That is a big deal. This will unfold over the next year, and you will see progress again occurring in that neighborhood."

McAdams said the waiver clears the way to fund providers to open the remaining of the 240 treatment beds planned as part of Operation Rio Grande. About 60 have already been opened and funded.

"Now it's a matter of securing the facilities and the construction," McAdams said. "We're going to be working hard to do that as quickly as possible."

What now?

While Utah leaders were celebrating, officials from the Utah Health Policy Project had mixed feelings about Wednesday's announcement

On one hand, the waiver's approval is a "big deal because it was the first time Medicaid has been extended to adults without dependents in Utah," said spokesman Jason Stevenson.

But on the other hand, Stevenson said there are an estimated 74,000 Utahns that will still fall in the Medicaid coverage gap.

"We applaud that more vulnerable people in Utah are going to get access and hopefully that will make a big difference for them, but we're also disappointed because there are so many left behind," said Micah Vorwaller, Utah Health Policy Project's policy analyst and legislative counsel.

Additionally, it's not clear how Utah's waiver could be affected by any health policy changes on the federal level.

Cox said the waiver operates under existing rules, regulations and legislation, but he added that it doesn't depend on the Affordable Care Act in any way, since it's something that Utah could have applied for long before the act.

"That being said, any changes that happen in health care … will obviously have an impact on this population," Cox said. "So we will continue to be engaged and work with our delegation on those issues."

If there aren't any changes to health policy on the federal level, however, Utahns covered under the waiver can expect solid coverage for at least five years, and likely longer.

Emma Chacon, operations director of Medicaid and Health Financing for Utah, said Utah's waiver won't expire until June 30, 2022, but Utah can easily ask to renew the waiver.

"The feds are usually pretty good about renewing them," she said.

"We'll have to wait and see" if there are any changes to federal policy, Chacon acknowledged, but said otherwise, she's confident Utah's waiver will be renewed in years to come.