SALT LAKE CITY — Utah is paying $2.5 million more each month than it would be paying under full Medicaid expansion.

And, it is only covering Utahns who earn up to 100% of the federal poverty level, whereas full expansion would cover individuals and families up to 138% of the federal poverty level.

While that is true, Rep. Jim Dunnigan, R-Taylorsville, said the numbers are misleading. The chairman of Utah’s Health Reform Task Force said, “It’s not accurate that we’re paying more for covering fewer people.”

The federal government, Dunnigan said, is currently paying all of the costs to subsidize the 41,000 Utahns who make between 100% and 138% of the federal poverty level and are enrolled on the federal insurance marketplace. Should those people become eligible for Medicaid — as they would under full expansion in Utah — the state would have to cover 10% of those costs, which, he said, is estimated to be $35 million a year.

But expansion is happening in Utah, just at the limits set by SB96, which lawmakers approved instead of Proposition 3.

The tally board shows the vote total — 22 to 7 — as the Senate concurs with changes made to SB96, the GOP leadership-backed replacement for the voter-approved Medicaid expansion ballot initiative, at the Capitol in Salt Lake City on Monday, Feb. 11, 2019.
FILE - The tally board shows the vote total — 22 to 7 — as the Senate concurs with changes made to SB96, the GOP leadership-backed replacement for the voter-approved Medicaid expansion ballot initiative, at the Capitol in Salt Lake City on Monday, Feb. 11, 2019. | Steve Griffin, Deseret News

Enrollment is open to anyone making up to 100% of the federal poverty level, which is $12,490 for individuals, or $25,750 for a family of four.

“Medicaid is open. The expansion is open,” Dunnigan said. “It is not capped. There is no work requirement. There is no community engagement requirement, at least this year. It’s free. It’s open (enrollment). Go sign up.”

Nate Checketts, director of the Medicaid program for the Utah Department of Health, said at least 30,000 Utahns have enrolled since the expansion opened April 1. Most of the new enrollees are between the ages of 26 and 44. Forty percent reside in Salt Lake County, 15% are in Utah County and 11% are in Weber County, with the remainder coming from cities all over the state.

Officials want to encourage anyone already enrolled or eligible to enroll to take advantage of the benefits offered to them.

“If you need health care, it is accessible to you,” Checketts said, adding that one requirement is legal Utah residency.

According to SB96, the state has to work through a couple of options before Medicaid would be fully expanded. If those proposals are not approved by U.S. Centers for Medicare and Medicaid Services by July 1, 2020, the department of health is to institute full expansion in Utah.

The Utah Department of Health is already working on a “fallback” waiver, as it got word last week from federal officials that elements of the state’s current proposal would not be approved. The federal government will not pay 90% of the cost for enrollees unless eligibility is expanded to 138% of the federal poverty level; and they also don’t approve Utah’s proposal of an enrollment cap. They have not made a determination on a per capita cap.

The state’s waiver is available for public comment at the federal level.

“In light of the discussions we’ve had with (Centers for Medicare and Medicaid Services) and the indication that they gave that they will not be approving two components of the per capita cap waiver, the department has begun the process for the fallback waiver request,” Checketts said, adding that the department is looking for input and ideas to cut costs for future expansion.

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Rep. Marie Poulson, D-Cottonwood Heights, said since the health department has already been told enrollment caps won’t fly, and that the work requirement isn’t holding up in courts for other states across the nation — both part of the next waiver to be submitted to the Centers for Medicare and Medicaid Services, the state may as well start work on full expansion now.

“Why can’t we just proceed to phase four, which is what the voters approved,” she said. “It looks like what we’re doing is prolonging the ability for these people to get health care and also paying three times the cost.”

If the state should get approval for its work requirement proposal, as well as a requirement that people take advantage of work-sponsored insurance programs, wherever offered, the next phase of expansion can be implemented. But, as the law states, full expansion, as dictated by the Affordable Care Act, would not be implemented prior to June 30, 2020.

Should the state get approval on the “fallback” waiver, Medicaid will, however, be expanded to 138% of the poverty level and that would be implemented as soon as Jan. 1, 2020.

The law would need to be changed to expedite the process, Checketts said.

“It’s the fiscally responsible thing to do,” Poulson said. “I find this really concerning.”

For more information about the Utah Medicaid program, visit medicaid.utah.gov.

Correction: Centers for Medicare and Medicaid Services rejected Utah’s proposal for an enrollment cap. It has not made a decision on the per capita cap, though a previous version stated it had. Also, full expansion could be implemented as soon as Jan. 1, 2020, under a different phase of SB96, should other proposals be approved.