Utah Decides Healthcare Act
Sponsor: Utah Decides Healthcare
This initiative would expand Medicaid to cover Utah citizens whose annual incomes are 138% of the federal poverty level or less (up to $26,900 for a family of three), closing the coverage gap for about 80,000 Utahns whose annual incomes are too high to qualify for Medicaid but not high enough to qualify for the federal health-care exchange. Thirty-two states have already adopted this expansion.
For both Medicaid and the Utah Children’s Health Insurance Program (CHIP), eligibility requirements and categories of care and services would not be permitted to become more restrictive than those in effect on Jan. 1, 2017. Also for both Medicaid and CHIP, the cost of premiums, enrollment and out-of-pocket expenses could not expand above those in place on Jan. 1, 2017; caps on enrollment would be limited to those in place on that date, as well..
Medicaid and CHIP payment rates to care providers for covered services, and payments to providers from contracted accountable-care organizations, could not decrease below those in effect on Jan. 1, 2017, subject to an annual adjustment.
To fund the state’s portion of this initiative, the sales-tax rate would be increased 0.15%, from 4.7% to 4.85%
"YES" Vote Means
Medicaid in Utah will expand to include all citizens with an annual income of 138% of the federal poverty level or less. (138% FPL is an annual income of $16,643 for an individual or $33,948 for a family of four)
Medicaid and CHIP services and benefits will not become more restrictive nor more costly to subscribers than those in effect on Jan. 1, 2017. Payments to providers will not be lower than the rates in effect on Jan. 1, 2017.
Utah will maximize federal financial participation to receive the full amount of federal matching funds available.
Utah’s sales tax will increase 0.15%, from 4.7% to 4.85%
"NO" Vote Means
There will be no change to Utah’s current funding and administration of Medicaid and CHIP.
The sale tax will remain at 4.7%.
Arguments in Support
- Low-income and homeless families and individuals will have access to reliable health care that is currently unavailable to those in the coverage gap.
- Lack of comprehensive health care can give rise to chronic conditions, such as asthma and diabetes, that drive up the cost of care overall. Expanding Medicaid can thus result in lower costs.
- Utahns pay federal taxes, but do not take full advantage of federal funds available for Medicaid and CHIP; by maximizing federal financial participation, the state will gain about $800 million in federal funds for health care.
- The initiative simply expands existing programs and networks, allowing flexibility in filling Utah’s specific needs.
- Medicaid benefits can help prevent low-income residents from becoming homeless.
- Fiscal uncertainties: Since the total cost of this program depends on factors including enrollment, it is not fixed or guaranteed; increases could negatively impact the state budget. In addition, if the federal government were to decrease its funding percentage, the state would be responsible for making up the shortfall.
- Policies generated by ballot initiatives may be difficult for voters to understand.
This initiative represents the latest in several attempts to expand Medicaid and close the coverage gap in Utah.
In 2014, Gov. Gary Herbert proposed the Healthy Utah Plan, a three-year pilot program that would use federal block-grant funds to help low-income residents pay for insurance in private markets. This plan failed in the Utah legislature in 2015, as did the more limited Utah Cares plan.
Last year, a small-scale plan to expand Medicaid to childless adults who suffer from homelessness, mental illness or addiction was passed by the legislature; this plan was meant to be implemented in January 2017, but it has not yet received federal approval. A second version of that plan, amended to include a work requirement and caps on enrollment and coverage, has been submitted in hopes of receiving federal approval to start in January 2018.
During the 2018 General Session, the Utah State Legislature passed a more limited version of Medicaid expansion. H.B. 472, sponsored by Rep. Robert Spendlove, would expand Medicaid to provide coverage for those up to 100% of the federal poverty level. The bill would expand Medicaid without increasing costs, by seeking a 90/10 match rate from the federal government, even though it is not a full expansion, and shifting around already-existing Medicaid funds. The bill would implement a work requirement for Medicaid beneficiaries and also includes an enrollment cap, whereby the state could cut off enrollment upon reaching a certain level of required funds.
This Medicaid expansion will be fully phased in by 2021. The Governor’s Office of Budget and Management estimates that, at full phase-in, the total expenses for the state will be $635,000,000, comprising $615,000,000 for Medicaid services and $20,000,000 for transportation. The increase in state sales tax from 4.7% to 4.85% would bring in $90,000,000 in additional revenue.
Additionally, the cost of distributing information about the proposed initiative in state newspapers and in the voter information pamphlet is $30,000 in one-time funds.
Utah Health Policy Project
The Fairness Project
Voices for Utah’s Children
Utah Academy of Pediatrics
People’s Health Clinic
Utah Legislative Coalition for People with Disabilities
Utah Disability Law Center
Utah Academy of Family Physicians
Utah Nurses Association
Utah Chapter of American Academy of Pediatrics
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